Category: AIDS

AIDS-Related Alveolar Hemorrhage: Conclusion

An increase in pulmonary circulation hydrostatic pressure is a frequent complication of severe renal impairment and left heart failure, sometimes creating the clinical and radiologic features of pulmonary edema. Studies of animal models have demonstrated the relationship between the increase in hydrostatic pressure in the pulmonary circulation and the occurrence of AH, showing “capillary stress failure” characterized by structural alteration of capillary basal membrane collagen…

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AIDS-Related Alveolar Hemorrhage: CMV

The apparent conflict with the results of another study might simply reflect differences in the status of the patients studied, as bleeding complications are mainly reported in those with advanced pulmonary diseases. The association between AH and pulmonary KS is clearly explained by pathologic studies. KS lesions are characterized by the proliferation of endothelial and spindle cells and by the extravasation of erythrocytes into the…

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AIDS-Related Alveolar Hemorrhage: Discussion

This analysis of 273 consecutive BAL specimens from HIV-infected patients showed the following: (1) that AH was present in about one third of patients but was usually clinically occult and cytolog-ically mild; (2) AH was clearly associated with specific underlying AIDS-associated pulmonary disorders, namely, pulmonary KS, CMV pneumonia, and hydrostatic pulmonary edema; and (3) AH was favored by triggering factors, especially thrombocytopenia. The high frequency…

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AIDS-Related Alveolar Hemorrhage: Risk Factors

Risk Factors for HIV-Related AH in Univariate Analysis Characteristics of HIV Infection and Potential Triggering Factors: As shown in Table 1, AH was associated with several factors. Compared with control subjects, patients were significantly more likely to be male, to belong to the homosexual HIV transmission category, and to have mucocutaneous KS. Immunodeficiency was also more severe in the patients, as shown by the higher…

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AIDS-Related Alveolar Hemorrhage: Results

Statistical Analysis Only the results of first BAL procedures performed during the study period were included in the analysis to ensure the independence of observations. Results were expressed as the mean ± SD. Univariate comparisons between cases (patients with AH) and controls (control subjects without AH) were performed with the Wald test by using nonconditional logistic regression for computing odds ratios (ORs) with 95% confidence…

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AIDS-Related Alveolar Hemorrhage: Fiberoptic Bronchoscopy, BAL Analysis, and AH Definition

Fiberoptic bronchoscopy and BAL were performed as previously described. BAL was conducted, after macroscopic examination for KS lesions and bronchial suppuration, in the middle lobe or in the most affected lung segment seen on the chest radiograph, using four 50-mL aliquots of warm sterile isotonic saline solution. The macroscopic aspect of recovered BAL fluid was noted, with special attention to signs of hemorrhage. BAL smears…

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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…

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