Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1501-1507

Role of Bronchoalveolar Lavage in Predicting Survival of Patients with Human Immunodeficiency Virus Infection

CARLO AGOSTINI, FAUSTO ADAMI, LEONARD W. POULTER, DOMINIQUE ISRAEL-BIET, MANUEL FREITAS E COSTA, ANGIOLO CIPRIANI, ROSARIA SANCETTA, MARC C. I. LIPMAN, KARINE JUVIN, ARTUR D. TELES-ARAÛJO, PAOLO CADROBBI, GUIDO MASAROTTO, and GIANPIETRO SEMENZATO

Padua University School of Medicine, Department of Clinical and Experimental Medicine, Padua, Italy; Royal Free Hospital School of Medicine, Department of Clinical Immunology, London, United Kingdom; Laennec Hopital, Paris, France; Lisboa University School of Medicine, Hospital de Santa Maria, Lisbon, Portugal; Padua Hospital, Divisions of Pneumophthysiology and Infectious Diseases, Padua, Italy; and Padua University School of Statistics, Department of Statistical Sciences, Padua, Italy

In this multicenter study, we investigated the prognostic factors that influence the risk of death in patients with human immunodeficiency virus (HIV) infection. Clinical and laboratory indices obtained from 161 HIV-seropositive patients who underwent a detailed morphologic and immunophenotypic evaluation of bronchoalveolar lavage (BAL) and peripheral blood cell populations were retrospectively analyzed. In 155 patients, death occurred within the 48-mo follow-up (mean follow-up: 14.8 mo; range: 1 to 48 mo). In the univariate analysis, the patient's age (> 30 yr), HIV disease status, HIV transmission category, number of opportunistic pathogens isolated from the BAL, percentage of BAL neutrophils, and low number of BAL CD4 T cells were predictive of increased mortality. In contrast, the presence of an alveolitis or an increase in the numbers of alveolar macrophages and CD3 T cells was associated with a decreased mortality. In the multivariate analysis, significant independent predictors were age, risk factor for HIV, and presence of an alveolitis. Furthermore, patients with a low number of BAL CD4 T cells had a particularly poor prognosis while the CD4 T-cell count in the peripheral blood (< 50 cells/mm³ in the majority of our patients) had a negligible effect on predicting survival. Our findings suggest the clinical utility of BAL analysis in patients infected with HIV.

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