Abstract
BACKGROUND: While the etiologies of solitary pulmonary nodules (SPNs) in immunocompetent patients are well established, common etiology, diagnostic techniques, and guidelines to assess SPNs in patients infected with human immunodeficiency virus (HIV) have not been established.
OBJECTIVE: To define the etiology of SPN in HIV-infected patients and to examine efficacy of diagnostic testing for SPN.
METHODS: We performed a retrospective chart review of HIV-infected patients admitted to a designated acquired immune deficiency syndrome (AIDS) center. Microbiological and histopathological specimens from sputum, bronchoalveolar lavage, and biopsies were analyzed. Charts were fully analyzed from time of admission until definitive diagnosis or loss to follow-up.
RESULTS: During the 10-year observational period, 10 of 5,000 HIV-infected patients admitted to the hospital were diagnosed with SPN via chest radiography or computed tomography (CT). Among these 10 patients, 6 had a definitive diagnosis. Underlying etiologies included infection (5/10) and lung adenocarcinoma (1/10); none were identified in the remaining 4 subjects. Sputum analysis provided no diagnostic value in discovering pathogenesis in any of these cases. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy were diagnostic in 3 cases, while CT-guided percutaneous transthoracic needle biopsy (PTNB) was diagnostic in 2 cases. One patient required open lung biopsy.
CONCLUSIONS: Etiologies of SPN in HIV-infected patients are varied and difficult to diagnose. In our study, SPN was attributable to infectious etiology in 50% of cases. Sputum analysis was of no diagnostic value. Biopsy is necessary for definitive diagnosis and treatment.
- pulmonary nodule
- human immunodeficiency virus
- acquired immune deficiency syndrome
- HIV infection
- diagnostic lung testing
Footnotes
- Correspondence: Vikas Pathak MD, Pulmonary Disease and Critical Care Medicine, University of North Carolina School of Medicine, 130 Mason Farm Road, Chapel Hill NC 27599. E-mail: drvikaspathak{at}gmail.com.
The authors have disclosed no conflicts of interest.
Dr Pathak presented a version of this paper at the 76th annual meeting of the American College of Chest Physicians, October 30–November 4, 2010, Vancouver, British Columbia, Canada.
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