Bronchoalveolar lavage phospholipid abnormalities in HIV-infected patients

Our aim was to evaluate the quality of pulmonary surfactant, a nonspecific defence system, during the course of human immunodeficiency virus) infection. Protein and phospholipid composition were determined in 127 bronchoalveolar lavage (BAL) fluids from 89 HIV seropositive patients (54 acquired immune deficiency syndrome (AIDS), 35 non-AIDS) and 11 healthy controls. In all of the HIV BAL samples, biochemical abnormalities were found. In subjects with pulmonary infection or Kaposi's sarcoma, the phospholipid/protein ratio was decreased, mainly because of elevated protein levels (15.8 and 20, respectively, vs 7.2 mg.100 ml-1 for controls, p < 0.05). In subjects without obvious pulmonary involvement, phospholipid was decreased (1.3 +/- 0.2 vs 2.9 +/- 0.3 mg.100 ml-1 for controls, p < 0.001), whereas the protein was not altered. Phospholipid composition was also altered: the phosphatidylcholine percentage was decreased, whilst the other main phospholipids were increased. We conclude that the alveolar lining is altered, whatever the stage of HIV disease. In most patients, it results from an increase of vascular permeability, with an influx of serum proteins. However, changes in phospholipid composition suggest that, in some cases, surfactant is also altered.