The Relationship Between Cytomegalovirus Retrieved by Bronchoalveolar Lavage and Mortality in Patients With HIV

¹ From the Department of Internal Medicine, University of Cincinnati Medical Center

Study objective: To evaluate mortality over 6 months of patients with HIV with cytomegalovirus (CMV) cultured from bronchoalveolar lavage (BAL) compared with those without CMV and to assess the significance of CMV cytologic study, CD4⁺ counts, and coexistent Pneumocystis carinii pneumonia.

Design: Retrospective evaluation of HIV-infected patients undergoing bronchoscopy with BAL. The 40 most recent HIV-positive patients undergoing bronchoscopy with BAL were included for each of three categories: CMV by cytologic study; CMV by culture only; and CMV absent. Patients for whom survival status at 6 months was unknown were excluded from analysis.

Setting: University hospital, tertiary care center.

Patients: Group 1 consisted of 36 patients with positive CMV culture and cytologic study and group 2 consisted of 38 patients with only a positive culture for CMV. Group 3 consisted of 40 patients with no evidence of CMV by BAL.

Results: On comparison of the groups, there was no difference in 3-week survival (from date of bronchoscopy). There was a statistically significant increase in mortality in group 1 patients compared with group 3 patients at both 3 and 6 months. Between groups 2 and 3, there was a difference in mortality that approached but did not reach significance at 3 months but did at 6 months. The mortality in group 1 at 3 months=28%, at 6 months=47%, whereas mortality in group 2 at 3 months=26% and at 6 months=45%. Group 3 had a 3-month mortality of 10% and a 6-month mortality of 15%. While those patients with positive CMV cytologic study had lower mean CD4⁺ counts, within the group, CD4⁺ counts were no different between the 3-month survivors and nonsurvivors (survivors, CD4/mm³ median=38 [0 to 141]; and nonsurvivors, CD4/mm³ median=16 [3 to 224]). Coninfection with P carinii did not increase mortality at 3 months.

Conclusions: The CMV retrieved by BAL in HIV-infected patients was associated with significantly greater 3- and 6-month mortality. The CMV cytologic study did not predict a higher mortality and the difference in mortality between patients with and without CMV in BAL fluid was not directly attributed to lower CD4⁺ counts or P carinii coinfection.

Key Words: acquired immunodeficiency syndrome • bronchoalveolar lavage • bronchoscopy • cytomegalovirus • pneumonia

Submitted on January 11, 1994
Accepted on August 19, 2007

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