CMV is a major cause of death for patients with AIDS. CMV pneumonia is often found at autopsy, but is rarely found antemortem for reasons that are not understood. As antipneumocystis prophylaxis is used more commonly, it is likely that CMV will become an increasingly important cause of morbidity and mortality. Effective anti-CMV drugs are now available. It is thus important to learn how to diagnose this entity invasively and non-invasively. This study will assess sputum, bronchoalveolar lavage, and transbronchial biopsy by a variety of conventional and novel approaches to CMV. Patients will be followed, but these data will not be used to determine therapy since their relevance is currently unknown. To date 8 asymptomatic patients with W infection have undergone bronchoscopy. Over 80% were culture positive for CMV. While 50% of patients had some evidence of non-specific interstitial pneumonitis, only two patients had any evidence of lung disease possibly due to CMV. The importance of this study is that it is a comprehensive effort to determine how CMV pneumonia can be diagnosed antemortem: while BAL cultures positive for CMV are common, CMV induced lung disease is not.
