Abstract
BackgroundChest radiographic abnormalities were common in HIV-infected individuals in the pre-combination antiretroviral therapy era, but findings may differ now due to a changing spectrum of pulmonary complications.MethodsCross-sectional study of radiographic abnormalities in an HIV-infected outpatient population during the antiretroviral therapy era. Demographics, chest computed tomography, and pulmonary function tests were obtained in HIV-infected volunteers without acute respiratory illness from the University of Pittsburgh HIV/AIDS clinic. Overall prevalence of radiographic abnormalities and potential risk factors for having any abnormality, nodules, or emphysema were evaluated using univariate and multivariable analyses.ResultsA majority of the 121 participants (55.4%) had a radiographic abnormality with the most common being emphysema (26.4%), nodules (17.4%), and bronchiectasis (10.7%). In multivariate models, age (odds ratio [OR] per year = 1.07, 95% confidence interval [CI] 1.04–1.14, p<0.001), pneumonia history (OR = 3.60, 95% CI = 1.27–10.20, p = 0.016), and having ever smoked (OR = 3.66, p = 0.013, 95% CI = 1.31–10.12) were significant predictors of having any radiographic abnormality. Use of antiretroviral therapy, CD4 cell count, and HIV viral load were not associated with presence of abnormalities. Individuals with radiographic emphysema were more likely to have airway obstruction on pulmonary function tests. Only 85.8% participants with nodules had follow-up imaging resulting in 52.4% having stable nodules, 23.8% resolution of their nodules, 4.8% development of a new nodule, and 4.8% primary lung cancer.ConclusionsRadiographic abnormalities remain common in HIV-infected individuals with emphysema, nodules, and bronchiectasis being the most common. Age, smoking, and pneumonia were associated with radiographic abnormalities, but HIV-associated factors did not seem to predict risk.
Highlights
With advancements in antiretroviral therapy (ART), chronic comorbidities of HIV have become more common as the life expectancy of those with HIV has increased [1,2,3,4]
The spectrum of lung diseases has changed, with conditions such as chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and lung cancer becoming more important in the current HIVinfected population [5,6,7,8,9]
About a quarter (23.1%) of the sample reported having had at least one prior episode of pneumonia requiring treatment and a smaller percentage reported a history of TB (9%)
Summary
With advancements in antiretroviral therapy (ART), chronic comorbidities of HIV have become more common as the life expectancy of those with HIV has increased [1,2,3,4]. Prior to the introduction of ART, studies in HIV-infected individuals reported high prevalence of radiographic abnormalities such as nodules, ground-glass opacities, and intrathoracic lymphadenopathy [10,11,12,13,14,15]. During the current era of HIV, radiographic findings may differ in light of the decreasing incidence of pulmonary infections, but few studies have re-examined radiographic findings on chest CT examination in the contemporary population [17]. Given the frequency of chronic respiratory complaints in HIVinfected populations [18,19] and the high prevalence of CT scanning [20], understanding radiographic manifestations of HIV is important for patient care. Chest radiographic abnormalities were common in HIV-infected individuals in the pre-combination antiretroviral therapy era, but findings may differ due to a changing spectrum of pulmonary complications
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