Infection with human immunodeficiency virus (HIV) is considered to be the most important public health problem of the twentieth century. HIV-associated respiratory tract infections, including tuberculosis and bacterial pneumonia, are the most important causes of morbidity and mortality in AIDS in the world, and Pneumocystis carinii pneumonia (PCP) is the most common AIDS-defining opportunistic infection in the United States. Many infectious, neoplastic, and other disorders have been linked with HIV infection. A list of HIV-associated respiratory disorders follows:

The risk of developing each of these disorders is influenced by genetic factors, place of residence, route of transmission of HIV, prior infections, severity of immunosuppression, and use of prophylactic and antiretroviral medications.<sup>1 Abouya Y.L., Beaumel A., Lucas S. , et al. Pneumocystis carinii pneumonia. A uncommon cause of death in African patients with acquired immuno-deficiency syndrome Am Rev Respir Dis 1992 ;  145 : 617-620

Cliquez ici pour aller à la section Références, 19 Centers for Disease Control and Prevention: USPHS/IDEA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: A summary MMWR Morb Mortal Wkly Rep 1995 ;  44 (RR-8) :

Cliquez ici pour aller à la section Références, 27 Daley C.L., Mugusi F., Chen L.L. , et al. Pulmonary complications of HIV infection in DaresSalaam Tanzania. Role of bronchoscopy and bronchoalveolar lavage Am J Respir Crit Care Med 1996 ;  154 : 105-110

Cliquez ici pour aller à la section Références, 33 Edwards L.B., Acquaviva F.A., Livesay V.T. , et al. An atlas of sensitivity to tuberculin, PPD-B, and histoplasmin in the United States Am Rev Respir Dis 1969 ;  99 (Suppl) : 1-132

Cliquez ici pour aller à la section Références, 46 Graham N.M.H., Zeger S.L., Park L.P. , et al. Effect of Zidovudine and Pneumocystis carinii prophylaxis on progression of HIV-one infection to AIDS: The multicenter AIDS cohorts study Lancet 1991 ;  338 : 265-269  [cross-ref]

Cliquez ici pour aller à la section Références, 71 Munoz A., Schrager L.K., Bacellar H. , et al. Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the multicenter AIDS cohort study: 1985–1991 Am J Epidemiol 1993 ;  137 : 423-438  [cross-ref]

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Since the beginning of the AIDS epidemic, flexible bronchoscopy (FB) has been invaluable in the diagnosis of these disorders. Rigorous assessment of the diagnostic usefulness of bronchoscopy in HIV-infected patients is difficult because large studies comparing the yield of bronchoscopic procedures with the gold standard of open lung biopsy (OLB) or autopsy are lacking; most patients with nondiagnostic bronchoscopic procedures are treated empirically. Nevertheless, a wealth of clinical experience supports the use of the procedure.<sup>12 Broaddus C., Dake M.D., Stulbarg M.S. , et al. Bronchoalveolar lavage and transbronchial biopsy for the diagnosis of pulmonary infections in the acquired immunodeficiency syndrome Ann Intern Med 1985 ;  102 : 747-752

Cliquez ici pour aller à la section Références, 72 Murray J.F., Felton C.P., Garay S.M. , et al. Pulmonary complications of the acquired immunodeficiency syndrome. Report of National Heart, Lung and Blood Institute Workshop N Engl J Med 1984 ;  310 : 1682-1688  [cross-ref]

Cliquez ici pour aller à la section Références, 75 Orenstein M., Webber C.A., Cash M. , et al. Value of bronchoalveolar lavage in the diagnosis of pulmonary infection in acquired immune deficiency syndrome Thorax 1986 ;  41 : 345-349  [cross-ref]

Cliquez ici pour aller à la section Références, 81 Rosen M.J., Tow T.W., Teirstein A.S. , et al. Diagnosis of pulmonary complications of the acquired immune deficiency syndrome Thorax 1985 ;  40 : 571-575  [cross-ref]

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In this article, the usefulness of bronchoscopy in diagnosing the common pulmonary complications associated with HIV infection is discussed. Alternatives to bronchoscopy are briefly reviewed. The information provided is likely to help the clinician plan a diagnostic approach to pulmonary complications of HIV disease.