Pulmonary diagnostic evaluation in patients suspected of having an HIV-related disease

The wide range of pulmonary infections associated with human immunodeficiency virus (HIV)-seropositivity, coupled with the possible presence of HIV-related neoplasms and non-HIV-related pulmonary processes, requires that most patients who are known to be or suspected of being HIV-seropositive should undergo a thorough diagnostic evaluation. This usually should include a screening evaluation that includes history, physical examination, screening laboratory tests, chest radiography, and arterial blood gas measurements. Pulmonary function testing and lung scanning also may be sensitive in screening, although these and the other procedures are nonspecific. Specific infectious organisms, particularly Pneumocystis carinii, may be identified through examination of induced sputum and by bronchoscopic procedures, including bronchoalveolar lavage and transbronchial biopsy. Open lung biopsy is not a routine part of the diagnostic evaluation. Although detection of recurrent episodes of pneumonia due to P carinii is difficult, empiric diagnosis and treatment of this disorder should be employed primarily when specific diagnostic techniques are unavailable or are refused.