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Clinical Investigations: HIV |

The Changing Pattern of Bronchoscopy in an HIV-Infected Population*

Simon Taggart, MD; Ronan Breen, MD; Neil Goldsack, MD; Caroline Sabin, PhD; Margaret Johnson, MD; Marc Lipman, MD
Author and Funding Information

*From the Royal Free Hospital HIV Centre, Hampstead, London, UK.

Correspondence to: Simon C. O. Taggart, BSc, MRCP, MD, Consultant Respiratory Physician, Trafford General Healthcare NHS Trust Hospital, Moorside Rd, Davyhulme, Manchester M41 5SL, UK; e-mail: scotaggart@hotmail.com



Chest. 2002;122(3):878-885. doi:10.1378/chest.122.3.878
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Study objectives: Little information exists on the impact of antiretroviral therapies (ARTs) on HIV-related bronchoscopic activity. This study was performed to identify any changes to our pattern of use of bronchoscopy over the last decade, and how this might relate to the introduction of more effective ARTs to our center in 1996.

Design: Retrospective data analysis.

Setting: Academic medical center.

Patients: HIV-positive patients attending the clinic.

Methods: Basic demographic details and bronchoscopy status were collected and compared for all patients with HIV attending our center between 1989 and 1998. Poisson regression analysis was performed to more formally identify the risk factors for bronchoscopy. Individual case notes and bronchoscopic findings were also examined for all patients undergoing bronchoscopy in 1990, 1995, and 1998.

Results: From 1996 to 1998, bronchoscopic rates fell dramatically by 60% (p < 0.0001) despite a linear increase in patients receiving follow-up. Prior use of protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor (NNRTI) combinations was significantly associated with a decreased risk of bronchoscopy even after adjusting for CD4 counts. Indications for bronchoscopy and diagnostic yield remained relatively stable in 1990, 1995, and 1998, although rates of pulmonary infection (Pneumocystis carinii pneumonia, bacteria, and virus) requiring bronchoscopy among our HIV population fell significantly from 1990 to 1998.

Conclusion: Improvements in HIV health care are having a dramatic impact on the rates of certain pulmonary infections requiring bronchoscopy. Of these, the introduction of more effective ARTs to our service in 1996 seems most closely related to the temporal decline in bronchoscopy. PI/NNRTI combinations may have additional protective effects to their recognized action on CD4 counts.


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