Chest
Clinical InvestigationsInfectionAIDS-Related Alveolar Hemorrhage: A Prospective Study of 273 BAL Procedures
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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