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January 22, 1996

Lack of Usefulness of Radiographic Screening for Pulmonary Disease in Asymptomatic HIV-Infected Adults

Author Affiliations

the Pulmonary Complications of HIV Infection Study Group

From the Beth Israel Medical Center, New York, NY (Drs Schneider and Rosen, and Ms Meiselman); Research Triangle Institute, Research Triangle Park, NC (Ms Hansen); Henry Ford Hospital, Detroit, Mich (Dr Kvale); Duke University Medical Center, Durham, NC (Drs Fulkerson and Goodman); Northwestern University, Chicago, Ill (Dr Glassroth); University of Medicine and Dentistry of New Jersey, Newark (Dr Reichman); University of California, Los Angeles (Dr Wallace); and University of California, San Francisco (Dr Hopewell). Members of the Pulmonary Complications of HIV Infection Study Group are listed on page 193.

Arch Intern Med. 1996;156(2):191-195. doi:10.1001/archinte.1996.00440020097011

Objective:  To determine the use of chest radiographs in the screening of asymptomatic adults infected with the human immunodeficiency virus (HIV).

Methods:  A prospective, multicenter study of the pulmonary complications of HIV infection in a community-based cohort of persons with and without HIV infection. The subjects included 1065 HIV-seropositive subjects without the acquired immunodeficiency syndrome at the time of enrollment: 790 homosexual men, 226 injection drug users, and 49 women with heterosexually acquired infection. Frontal and lateral chest radiographs were performed at 3-, 6-, and 12-month intervals, CD4 lymphocyte measurements at 3- and 6-month intervals, tuberculin and mumps skin tests at 12-month intervals, and medical histories and physical examinations at 3- and 6-month intervals. Pulmonary diagnoses that occurred within 2 months following each radiograph were analyzed and correlated with the radiographic results.

Results:  Evaluable screening chest radiographs (5263) were performed in HIV-seropositive subjects while they were asymptomatic; of these, 5140 (98%) were classified as normal and 123 (2%) as abnormal. A new pulmonary diagnosis was identified within 2 months following a screening radiograph in 55 subjects. Only 11 of these subjects had abnormal radiographs; the sensitivity of the radiograph was 20%. The sensitivity was similarly low at baseline, within each transmission category, and in subjects whose CD4 lymphocyte counts were less than 0.2× 109/L (200/μL). The types of pulmonary diseases that occurred were similar in the subjects with normal and abnormal screening radiographs.

Conclusion:  Screening chest radiography in asymptomatic HIV-infected adults is unwarranted because the diagnostic yield is low.(Arch Intern Med. 1996;156:191-195)