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Salzman Steve H. M.D.; Bernstein, Lori E. M.D.; Villamena, Patricia C. M.D.; Schneider, Roslyn F. M.D.; Mayo, Paul H. M.D.; Rosen, Mark J. M.D.
Journal of Bronchology: April 1996
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Bronchoscopy plays a central role in the evaluation of pulmonary complications of human immunodeficiency virus (HIV) infection. Some recommend routinely performing bronchoalveolar lavage (BAL) without bronchoscopic lung biopsy (BLB) because of the high sensitivity of BAL in diagnosing Pneumocystis carinii pneumonia (PCP). This retrospective, consecutive case study sought to clarify the complementary role of BLB performed in addition to BAL. One hundred eighty-two patients with known or suspected HIV infection had 205 bronchoscopic procedures to diagnose a pulmonary disorder. PCP was the final diagnosis in 111 (54%). An additional 16 disorders accounted for the remaining 82 diagnoses. Overall, bronchoscopy had a sensitivity of 91% for all diagnoses. BLB, when it was performed, was the exclusive source of a rapid diagnosis by microbiologic stains or histology in 42 of 162 (26%) of all diagnoses. This additive role was most important in noninfectious diagnoses, where BLB was the only test yielding the diagnosis in 20 of 32 (54%), and for infections other than PCP, where it was the only positive test in 14 of 35 (40%). BLB was the only test that yielded a diagnosis in 8 of 95 (8%) cases of PCP. This study supports the routine inclusion of BLB during bronchoscopy of HIV-infected patients.

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