Clinical and radiographic predictors of the etiology of pulmonary nodules in HIV-infected patients

Study objectives: To determine the etiology and the clinical and radiograph ic predictors of the etiology of pulmonary nodules in a group of HIV-infect ed patients. Design: Retrospective analysis. Setting: A large urban hospital in San Francisco, CA. Patients: HIV-infected patients evaluated at San Francisco General Hospital from June 1, 1993, through December 31, 1997, having one or more pulmonary nodules on chest CT. Main outcome measures: Three physicians reviewed medical records for clinic al data and final diagnoses. Three chest radiologists blinded to clinical d ata reviewed chest CTs, Univariate and multivariate analyses were performed to determine clinical and radiographic predictors of having an opportunist ic infection and the specific diagnoses of bacterial pneumonia and tubercul osis. Results: Eighty seven of 242 patients (36%) had one or more pulmonary nodul es on chest CT. Among those 87 patients, opportunistic infections were the underlying etiology in 57 patients; bacterial pneumonia (30 patients) and t uberculosis (14 patients) were the most common infections identified. Multi variate analysis identified fever, cough, and size of nodules < 1 cm on che st CT as independent predictors of having an opportunistic infection. Furth ermore, a history of bacterial pneumonia, symptoms for 1 to 7 days, and siz e of nodules < I cm on CT independently predicted a diagnosis of bacterial pneumonia; a history of homelessness, weight loss, and lymphadenopathy on C T independently predicted a diagnosis of tuberculosis. Conclusions: In HIV-infected patients having one or more pulmonary nodules on chest CT scan, opportunistic infections are the most common cause. Speci fic clinical and radiographic features can suggest particular opportunistic infections.