Clinical outcomes and complications of fiberoptic bronchoscopy in HIV-infected patients

Introduction
Respiratory diseases, including infectious and non-infectious complications are common among patients with human immunodeficiency virus (HIV) infection. We aimed to determine the performance of fiberoptic bronchoscopy (FOB), bronchoalveolar lavage, and transbronchial lung biopsy in HIV-infected patients.

Material and methods
The current retrospective study was performed in Masih Daneshvari Hospital, Tehran, Iran, from January 2003 to March 2017. Patients with HIV infection and 836 episodes of respiratory manifestations were selected. Indications, outcomes as well as results and complications of bronchoscopy were extracted. Performance of bronchoscopy to determine definite etiology and its ability to rule out other differential diagnoses were evaluated.

Results
The indications of FOB were found in 289 subjects (34.6%) with respiratory diseases, of whom only 220 patients had undergone the procedure. Bronchoscopy confirming a final diagnosis was found in 87 (39.5%) patients and a diagnostic benefit was noted for minimum 66.7% of the subjects. Diagnostic ability of bronchoscopy was higher in patients suspected of pneumocystis jiroveci pneumonia (PJP), tuberculosis (TB), cytomegalovirus (CMV) pneumonitis, and in cases with ground-glass opacity and diffuse lung infiltrates (p-value: 0.003 and 0.035, respectively), and lower for subjects demonstrating reticulonodular infiltrations and right middle and lower lobes involvement (p-value: 0.008, 0.005, and 0.045, respectively). Procedure-related complications were reported in five subjects.

Conclusions
FOB is a significantly advantageous and safe procedure in HIV-infected patients. Its diag­nostic yield is higher in patients with ground-glass opacity and diffuse infiltration in chest computed tomography scan.