Cellular and noncellular components of bronchoalveolar lavage fluid in HIV-1-infected children with radiological evidence of interstitial lung damage

Children with acquired immune deficiency syndrome (AIDS) commonly have recu rrent infectious and noninfectious lung complications that ultimately end i n death. To study the intensity of alveolar inflammation and to evaluate th e clinical utility of bronchoalveolar lavage (BAL) in children with HIV-1 i nfections, we retrospectively analyzed differential cell counts, lymphocyte subsets, and fibronectin and hyaluronic acid concentrations in BAL fluid o f 18 HIV-1-positive children (9 boys, mean age 3.5 years, range 5 months-8 years) with radiological evidence of interstitial lung disease, and 19 cont rol children who had undergone BAL for clinical indications not involving t he lung parenchyma (13 boys, mean age 3 years, range 2 months-14 years). BAL fluid from 89% of the HIV-I infected children showed CD8+ve lymphocytic alveolitis expressing HLA-DR, CD54, and CD 69 antigens. BAL fluid from HIV -infected patients typically contained markedly increased percentages and n umbers of lymphocytes (P < 0.0001) and eosinophils (P < 0.04) and significa ntly higher concentrations of albumin (P < 0.05) and fibronectin (P < 0.000 6) than fluids from control children. Whereas BAL cellular components did n ot differ in P, carinii-positive and P, carinii-negative HIV-l-infected chi ldren, fibronectin concentrations were significantly higher in P. carinii-p ositive than negative children. BAL cell differentials and noncellular comp onents were related neither to severity of disease nor to patients' disease progression. These findings indicate that BAL is useful in studying the intensity of lun g inflammation in children with HIV-1 infections and radiologically documen ted interstitial lung disease, but provides no information on the subsequen t clinical course.