Preferential recruitment of phagocytes into the lung of patients with advanced acquired immunodeficiency syndrome and tuberculosis

Limited data are available on the cellular and immunocytological characteri stics of bronchoalveolar lavage (BAL) fluid in individuals infected with th e human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB). The i mmune host response against tuberculosis in early HIV-infection may differ from that in later stages of HIV disease, as is strongly suggested by diffe rent clinical and radiographic patterns. We studied the cellular elements i n the lungs of 15 HIV-infected patients with advanced immunosuppression and pulmonary tuberculosis (TB/AIDS). The findings were compared with data fro m four other groups: 1) 15 HIV-seronegative patients with pulmonary TB; 2) 12 HIV-seropositive TB patients without previous AIDS-defining illnesses an d with CD4+ > 200 cells mm(-3); 3) five AIDS patients without pulmonary les ions; and 4) five healthy controls, BAL fluid and differential cell counts? as well as lymphocyte subsets, were determined. Despite a low CD4/CD8 rati o, the TB/AIDS group had a higher absolute number of CD8+ lymphocytes in th e BAL fluid than the other groups. Alveolar macrophages and neutrophils wer e significantly increased in TB/AIDS patients compared to control groups. T he number of eosinophils was increased in TB/HIV- patients but not in TB/AI DS patients. We conclude that tuberculosis in Late stage HIV-infected patie nts has a distinct inflammatory cell profile, suggesting an enhanced compen satory mechanism that amplifies the unspecific inflammatory reaction.