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Nonspecific Interstitial Pneumonitis without Evidence of Pneumocystis carinii in Asymptomatic Patients Infected with Human Immunodeficiency Virus (HIV)

Frederick P. Ognibene, MD; Henry Masur, MD; Paul Rogers, MD; William D. Travis, MD; Anthony F. Suffredini, MD; Irwin Feuerstein, MD; Vee J. Gill, PhD; Barbara F. Baird, RN; Jorge A. Carrasquillo, MD; Joseph E. Parrillo, MD; H. Clifford Lane, MD; and James H. Shelhamer, MD
[+] Article and Author Information

Requests for Reprints: Frederick P. Ognibene, MD, Critical Care Medicine Department, National Institutes of Health, Building 10, Room 10D48, 9000 Rockville Pike, Bethesda, MD 20892.

Current Author Addresses: Drs. Ognibene, Masur, Suffredini, Baird, Parrillo, and Shelhamer: Critical Care Medicine Department, National Institutes of Health, Building 10, Room 10D48, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Rogers: Pittsburgh V.A. Hospital, Pittsburgh, PA 15240.

Dr. Travis: National Institutes of Health, Building 10, Room 2N218, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Feuerstein: National Institutes of Health, Building 10, Room 1C660, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Gill: National Institutes of Health, Building 10, Room 2C385, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Carrasquillo: National Institutes of Health, Building 10, Room 1C401, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Lane: National Institutes of Health, Building 10, Room 11B09, 9000 Rockville Pike, Bethesda, MD 20892.


Ann Intern Med. 1988;109(11):874-879. doi:10.7326/0003-4819-109-11-874
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Study Objective: To assess how often Pneumocystis carinii organisms, P. carinii pneumonia, or other pulmonary pathologic processes were present in persons infected with human immunodeficiency virus (HIV) without pulmonary symptoms or previous history of P. carinii, and with a normal chest roentgenogram.

Design: Serial, prospective assessment of eligible HIV-seropositive patients over 21 months.

Patients: Twenty-four HIV-seropositive patients with either a nonpulmonary manifestation of the acquired immunodeficiency syndrome (AIDS) (n = 12) or an absolute CD4 lymphocyte count of 0.200 X 109 cells/L or less (n = 12), no pulmonary symptoms, a normal chest roentgenogram, no history of P. carinii pneumonia, and no history of treatment with antipneumocystis prophylaxis.

Interventions: Pulmonary assessment with arterial blood gases, pulmonary function tests, gallium-67 citrate scans, and bronchoscopy with bronchoalveolar lavage and transbronchial biopsies.

Measurements and Main Results: Mean alveolar-arterial gradient was 11.1 mm Hg ± 8.5 and mean diffusion capacity was 73.0% ± 20.0% of predicted. None of the 24 patients showed P. carinii or other pathogens on stains of bronchoalveolar lavage fluid. No patient had histologic evidence of P. carinii pneumonia. Transbronchial biopsy specimens showed chronic, nonspecific interstitial pneumonitis (11 of 23) and no pathologic abnormality (12 of 23). Six patients have developed P. carinii pneumonia during 2 to 18 months of follow-up.

Conclusions: HIV-infected patients without pulmonary symptoms did not have detectable Pneumocystis organisms in bronchoalveolar lavage fluid or transbronchial biopsy specimens; but 11 of 23 had evidence of chronic, nonspecific interstitial pneumonitis. Pneumocystis organisms in a pulmonary specimen from a symptomatic patient probably indicate the cause of the pulmonary dysfunction even if only a few are detected.

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