Chest
Volume 120, Issue 4, October 2001, Pages 1078-1084
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Clinical Investigations
Infection
AIDS-Related Alveolar Hemorrhage: A Prospective Study of 273 BAL Procedures

https://doi.org/10.1378/chest.120.4.1078Get rights and content

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

AH was assessed by using the Golde score. Data on the patients treated and observed in our institution were collected, as well as on their survival rate 12 months after undergoing BAL. Risk factors for AH were sought by comparing patients with AH (cases) and those without AH (control subjects).

Results

AH frequently occurred but usually was subclinical and cytologically mild. AH did not alter the 12-month survival rate. AH always was associated with at least one specific AIDS-related pulmonary disorder, and the following 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), cytomegalovirus (CMV) pneumonia (OR, 9.8; 95% CI, 1 to 100; p = 0.05), hydrostatic pulmonary edema (OR, 16.4; 95% CI, 1.8 to 142; p = 0.01), and platelet count < 60,000 cells/μL (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.

Section snippets

Study Design

Between January 1994 and December 1996, all BAL procedures performed in our institution on HIV-infected patients who had pulmonary symptoms and/or fever were evaluated prospectively for evidence of AH.

The characteristics of the patients, who were treated and observed in our institution, were collected from their medical charts. The group with AH (cases) was compared with the group without AH (control subjects) by using a stepwise forward logistic regression model to identify the risk factors

Frequency, Severity, and Clinical Features of HIV-Related AH

Two hundred seventy-three consecutive BAL procedures were performed in 243 patients during the 3-year study period. Eighty-eight samples (32%) revealed AH (mean GS, 65; GS range, 20 to 221). AH was severe (GS > 100) in 11 of the 88 patients (13%). As expected, there was a good correlation between the GS and the percentage of siderophages recovered by BAL in cases of AH (R2 = 0.9; p < 0.01; data not shown). Total and differential cell counts did not differ between BAL fluid from patients with AH

Discussion

This analysis of 273 consecutive BAL specimens from HIV-infected patients showed the following: (1) that AH was present in about one third of patients but was usually clinically occult and cytologically mild; (2) AH was clearly associated with specific underlying AIDS-associated pulmonary disorders, namely, pulmonary KS, CMV pneumonia, and hydrostatic pulmonary edema; and (3) AH was favored by triggering factors, especially thrombocytopenia. The high frequency of AH in this series is in keeping

Acknowledgment

We thank Isabelle Herry, Gilles Mangiapan, Jean-Marc Naccache, Fayçal Saïdi, and Kader Souidi for patient care and Jean-François Bernaudin for helpful criticism.

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