Am. J. Respir. Crit. Care Med., Vol 154, No. 1, Jul 1996, 105-110.
Pulmonary complications of HIV infection in Dar es Salaam, Tanzania. Role of bronchoscopy and bronchoalveolar lavage
CL Daley, F Mugusi, LL Chen, DM Schmidt, PM Small, E Bearer, E Aris, IM Mtoni, JP Cegielski, G Lallinger, I Mbaga and JF Murray
Division of Pulmonary and Critical Care Medicine, University of California, San Francisco 94143-0841, USA.
To determine the pulmonary complications in HIV-1-infected patients in Dar
es Salaam, Tanzania, and to evaluate the diagnostic utility of bronchoscopy
and bronchoalveolar lavage, we carried out a prospective study of 237
patients with acute respiratory disease who were hospitalized at Muhimbili
Medical Center (MMC). Diagnoses were made using well-defined criteria. Of
the total, 127 (54%) were HIV-1- seropositive and 110 (46%) were
seronegative. Tuberculosis was the most common diagnosis occurring in 95
(75%) HIV-1-seropositive and 87 (79%) seronegative patients. Bacterial
pneumonia was the next most common diagnosis occurring in 18 (14%)
HIV-1-seropositive and 17 (15%) seronegative patients. Pneumocystis carinii
pneumonia was diagnosed in one and Kaposi's sarcoma was seen in only two
HIV-1-seropositive patients. Bronchoscopy with bronchoalveolar lavage was
the sole source of a diagnosis in nine (8%) seropositive and six (5%)
seronegative patients. We conclude that the HIV seroprevalence rate among
patients hospitalized for acute respiratory disease at MMC is extremely
high. Tuberculosis was the most common cause of pulmonary disease,
regardless of HIV serostatus, and other HIV-associated opportunistic
pulmonary infections were unusual. Bronchoscopy with bronchoalveolar lavage
added little to the diagnosis and thus should not be high-priority
procedures for the routine workup in resource-poor areas where tuberculosis
is endemic.
