LACK OF USEFULNESS OF RADIOGRAPHIC SCREENING FOR PULMONARY-DISEASE INASYMPTOMATIC HIV-INFECTED ADULTS

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 comp lications of HIV infection in a community-based cohort of persons with and without HIV infection. The subjects included 1065 HIV-seropositiv e subjects without the acquired immunodeficiency syndrome at the time of enrollment: 790 homosexual men, 226 injection drug users, and 49 wo men with heterosexually acquired infection. Frontal and lateral chest radiographs were performed at 3-, 6-, and 12-month intervals, CD4 lymp hocyte measurements at 3- and 6-month intervals, tuberculin and mumps skin tests at 12-month intervals, and medical histories and physical e xaminations at 3- and 6-month intervals. Pulmonary diagnoses that occu rred within 2 months following each radiograph were analyzed and corre lated with the radiographic results. Results: Evaluable screening ches t radiographs (5263) were performed in HIV-seropositive subjects while they were asymptomatic; of these, 5140 (98%) were classified as norma l and 123 (2%) as abnormal. A new pulmonary diagnosis was identified w ithin 2 months following a screening radiograph in 55 subjects. Only 1 1 of these subjects had abnormal radiographs; the sensitivity of the r adiograph was 20%. The sensitivity was similarly low at baseline, with in each transmission category, and in subjects whose CD4 lymphocyte co unts were less than 0.2X10(9)/L (200/mu L). The types of pulmonary dis eases that occurred were similar in the subjects with normal and abnor mal screening radiographs. Conclusion: Screening chest radiography in asymptomatic HIV-infected adults is unwarranted because the diagnostic yield is low.