AIDS-Related Alveolar Hemorrhage
HIV infection predisposes patients to several infectious and noninfectious pulmonary diseases, The spectrum of noninfectious pulmonary diseases includes neoplasms (especially Kaposi’s sarcoma [KS]) and nonspecific disorders such as lymphocytic and nonspecific interstitial pneumonitis, primary pulmonary hypertension, emphysema, and bronchiolitis-organizing pneumonia.
Alveolar hemorrhage (AH), a feature of several immune and idiopathic disorders, corresponds to diffuse bleeding into the acinar portion of the lung. It is routinely diagnosed by macroscopic and cytologic examination of BAL fluid, especially in immunocompromised patients. During the past decade, BAL also has taken on a central role in the diagnosis of AIDS-related pulmonary disorders, but to our knowledge, the frequency of AH in this setting has never been studied specifically, except in patients with pulmonary KS and cytomegalovirus (CMV) pneumonia. canadianfamilypharmacy
The aim of this prospective study of HIV-infected patients was to evaluate the following: (1) the frequency and severity of AH and its effect on survival; and (2) the connection between AH and underlying AIDS-related pulmonary disorders and known AH triggering factors, such as thrombocytopenia, renal failure, and clotting disorders.
Materials and Methods
Between January 1994 and December 1996, all BAL procedures performed in our institution on HIV-infected patients who had pulmonary symptoms and/or fever were evaluated prospectively for evidence of AH.
The characteristics of the patients, who were treated and observed in our institution, were collected from their medical charts. The group with AH (cases) was compared with the group without AH (control subjects) by using a stepwise forward logistic regression model to identify the risk factors associated with the occurrence of AH. The 12-month survival rate after BAL also was studied according to the presence or absence of AH.
Published cases of AIDS-related AH and associated risk factors were identified by a MEDLINE search performed from 1980 to 1998 with the following key words: (alveolar or pulmonary or lung) and (hemorrhage or hemosiderosis) and HIV or AIDS. Only well-documented reports of AIDS-related AH were analyzed.