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Processing of Bronchoalveolar Lavage Fluid and Matched Blood for Alveolar Macrophage and CD4+ T-cell Immunophenotyping and HIV Reservoir Assessment
Published on: June 23, 2019
The role of lung biopsy in children with perinatally acquired AIDS
J R Oyarzun1, J V Cotroneo, R M DiDonato
1Division of Pediatric Cardiothoracic Surgery, Children's Hospital of New Jersey, Newark, USA.
Insights
Open lung biopsy (OLB) is a safe and effective diagnostic method for children with HIV-related lung disease, yielding positive results in all cases and guiding therapy. This procedure offers a definitive diagnosis for pulmonary infiltrates in pediatric HIV.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Diagnostic Pathology
Background:
- Pulmonary infiltrates are a significant concern in perinatal HIV infection.
- Diagnostic methods like open lung biopsy (OLB) and bronchoscopic techniques are debated for efficacy in this population.
- Accurate diagnosis is crucial for timely and effective treatment of pediatric HIV-related lung disease.
Purpose of the Study:
- To evaluate the safety and efficacy of open lung biopsy (OLB) in diagnosing HIV-related lung disease in children.
- To compare OLB outcomes with bronchoscopic techniques for pediatric HIV pulmonary infiltrates.
- To assess the impact of OLB findings on therapeutic decisions in pediatric HIV patients.
Main Methods:
- Conducted 27 open lung biopsies (OLBs) on 24 children diagnosed with HIV infection over a 6-year period.
- Procedures involved general anesthesia and limited anterolateral thoracotomy for specimen retrieval.
- Pathological analysis included evaluation for infectious (bacterial, viral, fungal, mycobacterial) and non-infectious causes.
Main Results:
- No operative deaths occurred; morbidity was low, with self-resolving air leaks in 8.3% of patients.
- A positive pathological finding was obtained in all specimens, leading to a change in therapy for all but one patient.
- Eight patients (33.3%) survived 2 to 8 years post-procedure, with late deaths attributed to AIDS.
Conclusions:
- Open lung biopsy (OLB) is a safe, simple, and highly effective diagnostic tool for pediatric HIV-related lung disease.
- Early consideration of OLB in carefully selected pediatric HIV patients can minimize complications and optimize treatment outcomes.
- The diagnostic yield of OLB is high, significantly impacting therapeutic management in this vulnerable population.
Abstract:
There is a need for a rapid and efficacious method of diagnosis of pulmonary infiltrates in perinatal HIV infection. However, controversy still exists about which method--open lung biopsy (OLB) versus bronchoscopic techniques--is the best for this population. We present our results with OLB in 24 children with HIV-related lung disease. Over a 6-year period, 27 OLBs were performed on 24 children with diagnosis of HIV infection. The procedures were performed under general anesthesia using a limited anterolateral thoracotomy. Suspicious areas were removed with the autostapler. The specimens were studied for the presence of non-infectious as well as bacterial, viral, fungal, and mycobacterial diseases. There were no operative deaths related to the procedure. Morbidity was limited to prolonged but self-resolving air leaks in two patients (8.3%). Five hospital deaths occurred between 3 and 12 weeks postoperatively and 11 late deaths between 3 months and 6.5 years. All deaths were related to AIDS. Eight patients (33.3%) are still alive 2 to 8 years postoperatively. A total of 43 pathologies were found in 27 specimens. A positive pathologic finding was obtained in all patients, with two patients having nonspecific minimal changes. This resulted in a change of therapy in all but one case. The technique of OLB in children with AIDS is safe and simple. It should be performed early in the course of the disease and, a careful selection of candidates can minimize the incidence of complications.
