Am. J. Respir. Crit. Care Med., Vol 149, No. 6, Jun 1994, 1591-1596.
Pulmonary disease associated with the human immunodeficiency virus in Kigali, Rwanda. A fiberoptic bronchoscopic study of 111 cases of undetermined etiology
J Batungwanayo, H Taelman, S Lucas, J Bogaerts, D Alard, A Kagame, P Blanche, J Clerinx, P van de Perre and S Allen
Department of Internal Medicine, Centre Hospitalier de Kigali, Rwanda.
All human immunodeficiency virus type 1 (HIV-1) infected adult patients
referred to the Division of Pulmonary Diseases of the Centre Hospitalier de
Kigali, Rwanda for evaluation of a pulmonary disease of undetermined
etiology (PDUE) were investigated by fiberoptic bronchoscopy using both
bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB). During a
10-mo period 111 HIV-1 infected patients with PDUE were examined, of whom
47 (42%) fulfilled the World Health Organization (WHO) clinical case
definition for acquired immunodeficiency syndrome (AIDS) and seven (6%) had
an AIDS-defining illness. Nonspecific interstitial pneumonitis was
diagnosed in 42 (38%) patients, tuberculosis in 25 (23%), cryptococcosis in
14 (13%), Kaposi's sarcoma (KS) in 10 (9%), Pneumocystis carinii pneumonia
(PCP) in five (5%). The diagnosis remained undetermined in 18 (16%)
patients. Chest radiograph patterns were generally nonspecific. TBB and BAL
had diagnostic yields of 82 and 26% of all final diagnoses, respectively.
Our study on Rwandese HIV-1-infected patients with PDUE provides evidence
for a large spectrum of pulmonary diseases with relative frequencies
differing strikingly from those in developed countries. Detailed
investigations confirm the rarity of PCP in Africa and highlight
nonspecific interstitial pneumonitis as the predominant diagnosis of PDUE.
Empiric antituberculosis treatment is justified in the absence of clinical
manifestations suggestive of a specific diagnosis and while awaiting the
results of the diagnostic procedures. Primary prophylaxis for PCP would not
be appropriate in Africa.
