AIDS-related alveolar hemorrhage - A prospective study of 273 BAL procedures

Study objectives: To evaluate the frequency and diagnostic significance of alveolar hemorrhage (AH) in HIV-infected patients. Design: A 3-year prospective cohort study. Setting: A university hospital in Paris, France. Patients: Two hundred forty-three HIV-infected patients undergoing 273 BAL procedures during the study period. Methods: AR was assessed by using the Golde score. Data on the patients tre ated and observed in our institution were collected, as well as on their su rvival rate 12 months after undergoing BAL. Risk factors for AH were sought by comparing patients with All (cases) and those without AH (control subje cts). Results: AH frequently occurred but usually was subclinical and cytological ly mild. AH did not alter the 12-month survival rate. AH always was associa ted with at least one specific AIDS-related pulmonary disorder, and the fol lowing four independent risk factors were identified in a stepwise forward logistic regression model: pulmonary Kaposi's sarcoma (KS; odds ratio [OR], 5.3; 95% confidence interval [CI], 1.8 to 16.7; p = 0.003), cytomegaloviru s (CN-IV) pneumonia (OR, 9.8; 95% CI, 1 to 100; p = 0.05), hydrostatic pulm onary edema (OR, 16.4; 95% CI, 1.8 to 142; p = 0.01), and platelet count < 60,000 cells/<mu>L (OR, 5.6; 95% CI, 1.5 to 20; p = 0.009). Conclusions: AH is frequently diagnosed during BAL in HIV-infected patients . Its presence may point to an underlying cause, such as pulmonary KS, CMV pneumonia, or hydrostatic pulmonary edema, or to triggering factors such as thrombocytopenia.