Pulmonary function tests in HIV-infected patients.

OBJECTIVE: To evaluate alterations in lung function during the course of HIV infection. DESIGN: Total lung capacity (TLC), the ratio of forced expiratory volume in one second to vital capacity (FEV1/VC), the carbon monoxide transfer factor (TLCO) and the alveolar-arterial oxygen gradient [delta (A-a)O2] were determined in this retrospective study. PATIENTS: Pulmonary function tests (PFT) were performed on 331 patients at various stages of HIV infection. Patients with a history of intravenous drug use or Kaposi's sarcoma were excluded. RESULTS: No significant differences were observed between the results for asymptomatic patients and those with AIDS-related complex (ARC). TLC, delta (A-a)O2 and TLCO were greatly altered in patients with acute Pneumocystis carinii pneumonia (PCP). No significant differences were observed in the TLC, delta(A-a)O2 or TLCO results between AIDS patients with no history of PCP and those with a history of a single episode of PCP. TLCO was significantly lower (P < 0.001) in AIDS patients with one previous episode of PCP than in the patients with ARC. Interestingly, both TLC and TLCO were significantly lower in the AIDS patients with no history of PCP than in the patients with ARC. Follow-up of 28 patients at different stages of HIV infection confirmed the alteration of PFT results in the late stages. CONCLUSIONS: The reasons for alterations in PFT results in PCP-free AIDS patients remain to be determined. Our findings suggest that PFT can provide valuable information throughout the course of HIV infection, particularly with regard to the indication for bronchoalveolar lavage.

Alteration of the alveolar-capillary membrane diffusing capacity in chronic left heart disease.

During left heart disease, the chronic increase in pulmonary capillary wedge pressure (PCWP) results both in vascular alterations with increased pulmonary vascular resistance (PVR), and in progressive thickening of the alveolar-capillary membrane, which diffusing capacity (Dm) is reduced. However, the total lung diffusing capacity for carbon monoxide (TLco) is inconstantly impaired, depending on the degree of pulmonary congestion. We evaluated the relation between the pulmonary hemodynamic repercussions of chronic heart disease and the 2 components of TLco, i.e., Dm and capillary blood volume. Forty-seven patients with chronic left heart disease (28 with valve disease, 19 with cardiomyopathy) underwent right heart catheterization with determination of PCWP and PVR. Pulmonary function tests, including spirometry, determination of TLco, and of its 2 components (percentage of predicted values) were performed in patients and in 15 healthy subjects. TLco and Dm, but not capillary blood volume, were significantly decreased in patients. Dm was related to PVR (p = 0.0006), and was markedly reduced in patients with high PVR (> or = 3 Wood U): 54 +/- 8% vs 80 +/- 19% in patients with normal PVR (p <0.0001). Dm < or = 66% identified all high PVR patients (sensitivity = 100%, specificity = 77%). Capillary blood volume was related to PCWP (p = 0.02), and was increased in patients with high PCWP (> 15 mm Hg): 126 +/- 30% vs 99 +/- 23% (p <0.01), but with a marked overlap. TLco values, although reduced in patients with high PVR (p <0.001), were not predictive of high PVR or high PCWP. Determination of Dm allows a more accurate detection of pulmonary hypertension complicating chronic left heart disease than the other pulmonary parameters.

Pulmonary tolerance of prophylactic aerosolized pentamidine in human immunodeficiency virus-infected patients.

The effects of primary and secondary long-term prophylaxis of Pneumocystis carinii pneumonia with aerosolized pentamidine on pulmonary function in HIV+ patients were evaluated. Eighty-one patients, none of whom were drug addicts or had pulmonary Kaposi's sarcoma, were studied. Fifty patients were receiving AP as secondary prophylaxis, 36 monthly and 14 twice-monthly; eight patients with a history of PCP served as control subjects. Twenty-three patients were receiving AP as primary prophylaxis, 12 monthly and 11 twice-monthly. Pulmonary function tests, including spirometry, lung transfer capacity for carbon monoxide (Tlco) and alveolar-arterial oxygen gradient (P[A-a]O2) were evaluated at M1, ie, one month after the diagnosis of PCP, or at the beginning of the AP prophylaxis, and then at three-month intervals (M4 to M13). No differences were observed in the results of spirometry or P(A-a)O2. Among the patients receiving secondary prophylaxis, a significant increase (paired Student's t-test) in Tlco occurred at M7 compared to M1 in the group receiving monthly administrations (p less than 0.01) and in the untreated control group (p less than 0.05); there was no significant difference in Tlco at M13 compared to M1 in the 12 patients who received monthly administrations for this period or at M7 in the 14 patients receiving AP twice-monthly. No significant difference in Tlco was observed at M7 in the primary prophylaxis groups. These results indicate that pulmonary tolerance of AP, as reflected by pulmonary function tests, is good.

Pulmonary capillary blood volume in patients with probable pulmonary Kaposi's sarcoma.

BACKGROUND: An increase in pulmonary capillary blood volume secondary to angiogenesis has been described in Kaposi's sarcoma. The value of the pulmonary capillary blood volume as an early marker of pulmonary Kaposi's sarcoma was evaluated. METHODS: In a prospective study 45 HIV positive patients (nine asymptomatic for Kaposi's sarcoma, 29 with cutaneous or mucocutaneous Kaposi's sarcoma, and seven with pulmonary Kaposi's sarcoma), underwent pulmonary function tests and determination of transfer capacity for carbon monoxide (TLCO) with its components, pulmonary capillary volume and membrane factor. RESULTS: Total lung capacity (TLC), TLCO, and its components were similar in the three groups. TLCO was normal in patients with pulmonary Kaposi's sarcoma and no changes in membrane factor or pulmonary capillary volume were observed. CONCLUSION: Pulmonary function tests and pulmonary capillary volume alone are not useful for identifying patients with pulmonary Kaposi's sarcoma.