Retrospective analysis of the efficacy of open lung biopsy in acquired immunodeficiency syndrome.

Open lung biopsy (OLB) was performed on 66 patients with acquired immunodeficiency syndrome from November 1981 through December 1987. Twenty-two patients with severe respiratory failure died within a month, 3 during operation. Fourteen patients with negative transbronchial biopsy and 19 with failure of treatment based on transbronchial biopsy died within a year. Six were alive and 5 were lost to follow-up. The most common organism found in patients with severe respiratory failure was Pneumocystis carinii alone or with other pathogens. Successful therapeutic change based on OLB findings was possible in only 1 (1.5%) of the 66 patients. Open lung biopsy has limited application in the management of acquired immunodeficiency syndrome. In patients with overt pulmonary failure, OLB is invariably fatal. Those seen with suspicious lung infiltrates without risk factors or with known risk factors and negative transbronchial biopsy results might benefit from OLB. In our institution, 18 of 64 acquired immunodeficiency syndrome admissions underwent OLB in 1983, whereas in 1987, only 2 of 302 patients admitted with acquired immunodeficiency syndrome had OLB.