Am. J. Respir. Crit. Care Med., Vol 155, No. 5, May 1997, 1723-1728.
Lack of clinical utility of bronchoalveolar lavage cultures for cytomegalovirus in HIV infection
M Mann, JH Shelhamer, H Masur, VJ Gill, W Travis, D Solomon, J Manischewitz, F Stock, HC Lane and FP Ognibene
Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1662, USA.
This study assessed the presence of cytomegalovirus (CMV) in
bronchoalveolar lavage (BAL) in three subpopulations of HIV-infected
patients and correlated its presence with clinical status during 3 mo of
follow-up. Nineteen asymptomatic volunteers, six patients with CMV
retinitis, and 46 patients with acute pulmonary symptoms underwent BAL and
were assessed for CMV by cytopathology, conventional shell vial cultures,
and antigen detection. Transbronchial biopsies were also obtained when
possible and evaluated for histopathologic changes of CMV. All patients
were followed for approximately 3 mo. Cytomegalovirus was detected in BAL
in nine of 19 (47%) asymptomatic volunteers, in all six patients with CMV
retinitis, and in 33 of 46 (72%) patients with pulmonary symptoms. Only one
symptomatic patient with a positive CMV BAL culture developed clinically
significant CMV pulmonary disease; this patient developed disseminated CMV
and died. The only other death occurred in a patient with CMV retinitis who
developed staphylococcal bacteremia. None of the asymptomatic volunteers or
patients with CMV retinitis developed evidence of CMV pneumonia or any
other organ disease with CMV. Cytomegalovirus is frequently detected in BAL
from HIV-infected patients regardless of their pulmonary symptoms and its
presence does not clinically predict significant pulmonary morbidity or
mortality in 3 mo of follow-up.
