The changing pattern of bronchoscopy in an HIV-infected population.
OBJECTIVE
s: Little information exists on the impact of antiretroviral therapies (ARTs) on HIV-related bronchoscopic activity. This study was performed to identify any changes to our pattern of use of bronchoscopy over the last decade, and how this might relate to the introduction of more effective ARTs to our center in 1996.


METHODS
Retrospective data analysis.


METHODS
Academic medical center.


METHODS
HIV-positive patients attending the clinic.


METHODS
Basic demographic details and bronchoscopy status were collected and compared for all patients with HIV attending our center between 1989 and 1998. Poisson regression analysis was performed to more formally identify the risk factors for bronchoscopy. Individual case notes and bronchoscopic findings were also examined for all patients undergoing bronchoscopy in 1990, 1995, and 1998.


RESULTS
From 1996 to 1998, bronchoscopic rates fell dramatically by 60% (p < 0.0001) despite a linear increase in patients receiving follow-up. Prior use of protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor (NNRTI) combinations was significantly associated with a decreased risk of bronchoscopy even after adjusting for CD4 counts. Indications for bronchoscopy and diagnostic yield remained relatively stable in 1990, 1995, and 1998, although rates of pulmonary infection (Pneumocystis carinii pneumonia, bacteria, and virus) requiring bronchoscopy among our HIV population fell significantly from 1990 to 1998.


CONCLUSIONS
Improvements in HIV health care are having a dramatic impact on the rates of certain pulmonary infections requiring bronchoscopy. Of these, the introduction of more effective ARTs to our service in 1996 seems most closely related to the temporal decline in bronchoscopy. PI/NNRTI combinations may have additional protective effects to their recognized action on CD4 counts.
Taggart
Simon
S
Royal Free Hospital HIV Centre, Hampstead, London, UK. scotaggart@hotmail.com
Breen
Ronan
R
Goldsack
Neil
N
Sabin
Caroline
C
Johnson
Margaret
M
Lipman
Marc
M
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001999:Bronchoscopy / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom; D014600:Utilization Review
D019380:Anti-HIV Agents