Lung infiltrates in antiretroviral-naive HIV-infected children with chronic lung disease: value of non-bronchoscopic bronchoalveolar lavage in the detection of Candida albicans.

OBJECTIVE To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with chronic persistent/recurrent lung disease in whom routine cultures were negative and were non-responders to World Health Organization standard antimicrobial therapy. METHOD Non-bronchoscopic bronchoalveolar lavage (NBBAL) was performed on these non-responders. RESULTS Fifty children were enrolled. Single isolates on NBBAL were seen in 28 cases, dual pathogens in 5 cases and no growth in 14 cases. Haemophilus influenzae (n = 12), Candida albicans (n = 5) and Mycobacterium spp. other than tuberculosis (n = 4) were the commonest pathogens seen. Eight cases with no growth had segmental or lobar collapse: in five cases, NBBAL was therapeutic and in two cases, a diagnosis of lymphoma was made on open lung biopsy. Thirty-two of the 38 cases (84%) had favorable outcomes on follow-up. CONCLUSION Haemophilus influenzae, C. albicans and Mycobacterium spp. other than tuberculosis are important pathogens in children with HIV and HIV-associated chronic lung disease.