Nonspecific interstitial pneumonitis without evidence of Pneumocystis carinii in asymptomatic patients infected with human immunodeficiency virus (HIV).
OBJECTIVE
To assess how often Pneumocystis carinii organisms, P. carinii pneumonia, or other pulmonary pathologic processes were present in persons infected with human immunodeficiency virus (HIV) without pulmonary symptoms or previous history of P. carinii, and with a normal chest roentgenogram.


METHODS
Serial, prospective assessment of eligible HIV-seropositive patients over 21 months.


METHODS
Twenty-four HIV-seropositive patients with either a nonpulmonary manifestation of the acquired immunodeficiency syndrome (AIDS) (n = 12) or an absolute CD4 lymphocyte count of 0.200 X 10(9) cells/L or less (n = 12), no pulmonary symptoms, a normal chest roentgenogram, no history of P. carinii pneumonia, and no history of treatment with antipneumocystis prophylaxis.


METHODS
Pulmonary assessment with arterial blood gases, pulmonary function tests, gallium-67 citrate scans, and bronchoscopy with bronchoalveolar lavage and transbronchial biopsies.


RESULTS
Mean alveolar-arterial gradient was 11.1 mm Hg +/- 8.5 and mean diffusion capacity was 73.0% +/- 20.0% of predicted. None of the 24 patients showed P. carinii or other pathogens on stains of bronchoalveolar lavage fluid. No patient had histologic evidence of P. carinii pneumonia. Transbronchial biopsy specimens showed chronic, nonspecific interstitial pneumonitis (11 of 23) and no pathologic abnormality (12 of 23). Six patients have developed P. carinii pneumonia during 2 to 18 months of follow-up.


CONCLUSIONS
HIV-infected patients without pulmonary symptoms did not have detectable Pneumocystis organisms in bronchoalveolar lavage fluid or transbronchial biopsy specimens; but 11 of 23 had evidence of chronic, nonspecific interstitial pneumonitis. Pneumocystis organisms in a pulmonary specimen from a symptomatic patient probably indicate the cause of the pulmonary dysfunction even if only a few are detected.
Ognibene
F P
FP
Clinical Center, National Institutes of Health, Bethesda, Maryland.
Masur
H
H
Rogers
P
P
Travis
W D
WD
Suffredini
A F
AF
Feuerstein
I
I
Gill
V J
VJ
Baird
B F
BF
Carrasquillo
J A
JA
Parrillo
J E
JE
D000328:Adult; D000818:Animals; D001992:Bronchoalveolar Lavage Fluid / Q000469:parasitology; D001999:Bronchoscopy; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications* / Q000469:parasitology; D006801:Humans; D007958:Leukocyte Count; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011010:Pneumocystis / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000209:etiology; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000473:pathology; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests; D013183:Sputum / Q000469:parasitology; D006377:T-Lymphocytes, Helper-Inducer