Leukotriene B4 and interleukin-8 in human immunodeficiency virus-related pulmonary disease.
OBJECTIVE
To investigate the pathogenesis of lung injury in Pneumocystic carinii pneumonia and nonspecific interstitial pneumonitis (NIP), common pulmonary complications of human immunodeficiency virus (HIV) infection. The efficacy of corticosteroid therapy in P carinii pneumonia and the observation that bronchoalveolar lavage (BAL) neutrophilia predicts a poor prognosis support the premise that the lung injury of P carinii pneumonia is due to the host's inflammatory response to the infection.


METHODS
In vitro measurements on previously collected BAL fluid samples.


METHODS
The Clinical Center of the National Institutes of Health, a research hospital and tertiary care referral center.


METHODS
Five normal volunteers, 5 asymptomatic HIV-positive patients, 10 HIV-positive patients with NIP (5 asymptomatic and 5 with respiratory symptoms), and 19 HIV-positive patients with P carinii pneumonia.


RESULTS
BAL leukotriene B4 (LTB4), interleukin 8 (IL-8), and phospholipase A2 (PLA2) were measured. IL-8 and PLA2 were elevated in patients with P carinii pneumonia, and IL-8 correlated with BAL fluid absolute neutrophil count. LTB4, IL-8, and PLA2 levels were elevated in patients with NIP; LTB4 and PLA2 levels correlated with absolute neutrophil count, and IL-8 correlated with alveolar-arterial oxygen pressure difference. IL-8 was elevated in the asymptomatic HIV-positive patients, and there was a trend toward elevation of PLA2 in this group.


CONCLUSIONS
IL-8 appears to play a role in the pathogenesis of lung injury in P carinii pneumonia and may be the principal neutrophil chemotaxin in this disease; PLA2 may also be involved in the pathogenesis of P carinii pneumonia. Both LTB4 and IL-8 may be involved in the recruitment of neutrophils and subsequent lung injury of NIP. These data suggest that there are varying mechanisms by which inflammatory cells are recruited to the lung in different HIV-related lung diseases.
Critical Care Medicine Department, Warren G. Magnuson Clinical Center, Bethesda, MD.
G Y
GY
Lipschik
M E
ME
Doerfler
J A
JA
Kovacs
W D
WD
Travis
V A
VA
Andrawis
M G
MG
Lawrence
J R
JR
Dichter
F P
FP
Ognibene
J H
JH
Shelhamer
D017088:AIDS-Related Opportunistic Infections / Q000378:metabolism; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002851:Chromatography, High Pressure Liquid; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006679:HIV Seropositivity / Q000378:metabolism; D006801:Humans; D016209:Interleukin-8 / Q000032:analysis*; D007975:Leukotriene B4 / Q000032:analysis*; D008171:Lung Diseases / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010741:Phospholipases A / Q000032:analysis; D054467:Phospholipases A2; D011020:Pneumonia, Pneumocystis / Q000378:metabolism; D011658:Pulmonary Fibrosis / Q000150:complications / Q000378:metabolism
D016209:Interleukin-8; D007975:Leukotriene B4; D010741:Phospholipases A; D054467:Phospholipases A2