UNEXPECTED LUNG LESIONS IN HIGH-RESOLUTION COMPUTED-TOMOGRAPHY (HRTC)AMONG PATIENTS WITH ADVANCED HIV DISEASE

The present pilot study was undertaken to characterize the frequency o f lung lesions in asymptomatic human deficiency virus (HIV) infected i ndividuals with advanced HIV disease, Thirty two consecutive HIV+ homo sexual males assessed for initiation of Pneumocystis carinii pneumonia (PCP) prophylaxis, were prospectively studied, All patients underwent a complete medical history, physical examination, pulmonary function tests and high resolution computed tomography (HRCT), HRCT scans were read by a single radiologist, who was blind as to the clinical status of the patient, Unexpected HRCT scan lesions were found in 60% of pati ents, There were no statistically significant differences between pati ents with normal and abnormal HRCT with respect to age, height, weight , CD4+ count, smoking history, serum albumin, alpha l-antitrypsin leve l or body mass index. Forced vital capacity (FVC) (% of predicted) and peak expiratory flow rate (PEFR) (% pred) were not significantly diff erent between groups, For patients with normal and abnormal HRCT force d expiratory volume in one second (FEV1) (% pred) was 99+/-12 vs 92+/- 16, FEV1/FVC was 82+/-5 vs 76+/-9, and forced mid-expiratory flow (FEF 25-75) (% pred) was 100+/-24 vs 77+/-27, respectively, There were no s tatistically significant differences between patients presenting with destructive versus nondestructive lung HRCT lesions, Our results demon strate that as many as 60% of HIV-infected patients have unexpected ab normalities on HRCT at the time of starting PCP prophylaxis, We specul ate that these lesions may contribute to the high frequency of spontan eous pneumothoraces previously reported in this patient population.