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Abraham Verghese, MD; Mounzer Al-Samman, MD; Della Nabhan, PA(C); Anthony D. Naylor, MD; Manuel Rivera, MD

Arch Intern Med. 1994;154(18):2086-2091.

Abstract
Background
Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (HIV) infection. We noted an increased incidence of bacterial bronchitis and bronchiectasis in our patients with HIV infection.

Methods
This study was conducted on persons with HIV infection at a county hospital and clinic. Bronchiectasis was diagnosed by bronchogram and computed tomography in one patient and by computed tomography alone in two others. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. Bronchoscopy with bronchoalveolar lavage was performed in patients with bronchitis to eliminate other causes of bronchial inflammation.

Results
Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these patients was 0.061 x10⁹/L (range, 0.001 to 0.203 x10⁹/L). The most common pathogens in 18 episodes of bacterial bronchitis were Haemophilus influenzae and Streptococcus pneumoniae (five episodes each) and Pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patients with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, HIV infection are described. Their mean CD4 cell count was 0.03 x10⁹/L (range, 0.024 to 0.037 x10⁹/L ). Haemophilus influenzae, Staphylococcus aureus, Pseudomonas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain.

Conclusions
Recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronchitis may lead to bronchiectasis, which may be more common in HIV infection than generally appreciated.

(Arch Intern Med. 1994;154:2086-2091)

Author Affiliations
From the Division of Infectious Diseases (Dr Verghese and Ms Nabhan), Department of Internal Medicine (Dr Al-Samman and Ms Nabhan), and Department of Radiology (Dr Naylor), and Division of Pulmonary Diseases (Dr Rivera), Texas Tech University Health Sciences Center, El Paso. Dr Al-Samman is now with the University of California—Los Angeles Medical Center.

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