title: Role of bronchoalveolar lavage in predicting survival of patients with human immunodeficiency virus infection.
abstract: 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.
authors.affiliation: Padua University School of Medicine, Department of Clinical and Experimental Medicine, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Agostini
authors.forename: F
authors.initials: F
authors.lastname: Adami
authors.forename: L W
authors.initials: LW
authors.lastname: Poulter
authors.forename: D
authors.initials: D
authors.lastname: Israel-Biet
authors.forename: M
authors.initials: M
authors.lastname: Freitas e Costa
authors.forename: A
authors.initials: A
authors.lastname: Cipriani
authors.forename: R
authors.initials: R
authors.lastname: Sancetta
authors.forename: M C
authors.initials: MC
authors.lastname: Lipman
authors.forename: K
authors.initials: K
authors.lastname: Juvin
authors.forename: A D
authors.initials: AD
authors.lastname: Teles-Araûjo
authors.forename: P
authors.initials: P
authors.lastname: Cadrobbi
authors.forename: G
authors.initials: G
authors.lastname: Masarotto
authors.forename: G
authors.initials: G
authors.lastname: Semenzato
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000382:microbiology; D017252:CD3 Complex / Q000032:analysis; D018791:CD4 Lymphocyte Count; D002452:Cell Count; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality*; D006801:Humans; D016131:Lymphocyte Subsets; D016676:Macrophages, Alveolar / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011010:Pneumocystis / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D017252:CD3 Complex