Bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are useful methods for the diagnosis of pulmonary diseases in patients infected with the human immunodeficiency virus (HIV). However, data on the accuracy of these techniques are conflicting. In order to estimate the sensitivity of the bronchoalveolar lavage, bronchial and transbronchial biopsy in pulmonary disease diagnosis in patients infected with HIV, the authors studied 71 consecutive patients, most of them with respiratory symptoms up to 15 days (58%) and radiologic signs of interstitial infiltrates (62%). The sensitivity was calculated taking as reference a constructed gold-standard, represented by the sum of all three techniques combined. Sensitivities for bronchoalveolar lavage, transbronchial biopsy, and bronchial brush were 86%, 43% and 5%, respectively. The association of bronchoalveolar lavage and transbronchial biopsy reached the sensitivity to 100%, reflecting how the gold-standard was constructed. The complication rate of the procedures was 3%. These results suggest that, in this population: (1) bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are secure procedures with good diagnostic performance; (2) bronchoalveolar lavage alone has reached the highest sensitivity, whereas both bronchoalveolar lavage and transbronchial biopsy can be considered complementary techniques; (3) the association of bronchoalveolar lavage and transbronchial biopsy performed better than bronchoalveolar lavage alone; and (4) the use of bronchial brush in the sequence used in this protocol did not have any influence on the performance of diagnosis.

Keywords: Human immunodeficiency virus. Lung diseases. Diagnostic techniques. HIV. Lung infections.