AIDS-Related Alveolar Hemorrhage: Data Collection and Follow-up

AIDS-Related Alveolar Hemorrhage: Data Collection and Follow-upDiagnostic criteria for CMV pneumonia were the following: (1) the presence of viral inclusions in BAL or transbronchial biopsy specimens; (2) the absence of other demonstrable pathogens; and (3) a marked improvement after specific treatment. Pulmonary KS was diagnosed on tissue specimens or when the operator described compatible endobronchial lesions associated with histologically proven skin lesions. Pulmonary lymphoma was established by the histologic analysis of tissue specimens. The diagnosis of lymphoid interstitial pneumonitis was confirmed after 3 months of follow-up of patients with intense CD8 lymphocytic alveolitis seen in BAL fluid specimens and a compatible histology in transbronchial biopsy specimens. The diagnosis of primary pulmonary hypertension and congestive heart failure was based on echocardiography examination and/or invasive hemodynamic evaluation by right-sided heart catheterization when indicated. Hydrostatic pulmonary edema was diagnosed in the presence of the following: (1) a diffuse alveolar and interstitial pattern on chest radiographs; (2) renal or cardiac failure; and (3) rapid and complete resolution of respiratory symptoms after fluid withdrawal by diuretic administration or hemodialysis. Finally, a diagnosis of nonpulmonary disease was considered when the pulmonary workup showed no lung disorder in patients with fever.

Data Collection and Follow-up
The following epidemiologic data were recorded at the time of BAL: sex; age; race; HIV transmission category; CD4+ lymphocyte count; prior AIDS-defining conditions, according to the Centers for Disease Control and Prevention classification; previous treatments; and P carinii pneumonia (PCP) prophylaxis. Particular attention was paid to the presence of mucocutaneous KS. The usual features of AH (ie, hemoptysis, anemia [hemoglobin concentration], hypoxemia [Pao2/fraction of inspired oxygen ratio], and new pulmonary infiltrates on the chest radiographs) also were recorded. In addition, chest radiographs were reviewed and classified in the following manner: (1) normal; (2) alveolointerstitial pattern; and (3) nodular pattern. Finally, the following factors that have been reported classically to trigger or aggravate AH were noted: smoking history (pack-years); thrombocytopenia (ie, platelet count, < 60,000 cells/^L); clotting abnormalities (ie, patient-to-control subject ratio of the activated partial thromboplastin time [APTT] of > 1.5 and thromboplastin time of < 60%), renal failure (ie, creatinine concentration of > 130 |j,mo]/L), congestive heart disease, and mechanical ventilation.

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Tags: AIDS, alveolar hemorrhage, cytomegalovirus, Kaposi’s sarcoma, pulmonary edema, thrombocytopenia