Four-year study of abdominal ultrasound in 900 Central African adults withAIDS referred for diagnostic imaging

Background: In the majority of sub-Saharan African countries, the absence o f computed tomography facilities makes abdominal ultrasound (US) an alterna tive diagnostic tool in the clinical investigation of infectious and noninf ectious complications of human immunodeficiency virus (HIV)-infected indivi duals. We studied the abdominal US findings in Central African adult AIDS p atients to determine whether the findings were consistent between different population groups and neighboring countries. We performed a longitudinal s tudy of AIDS patients and age- and sex-matched HIV-negative adults referred for abdominal US at two tertiary referral city hospitals: the Gecamines Se ndwe Hospital (GSH), Lubumbashi, Congo, and the University Teaching Hospita l (UTH), Lusaka, Zambia. Methods: Between 1992 and 1996, abdominal US findings in 900 adults (300 Co ngolese adults from GSH and 600 Zambian adults from UTH; age range = 15-55 years) with a diagnosis of AIDS referred for diagnostic imaging from the in patient medical wards were recorded; 900 abdominal ultrasound findings from age and sex-matched HIV-negative adults were studied for comparative purpo ses. Results: Abdominal US for diagnostic purposes in AIDS patients is requested by clinicians for a range of primary clinical indications: abdominal pain, fever of unknown origin, hepatosplenomegaly, lymphadenopathy, and abnormal liver function tests. Compared with the HIV-individuals, the AIDS group of patients had a significantly higher proportion of splenomegaly (35% vs. 24 %; p less than or equal to 0.001), hepatomegaly (35% vs. 22%; p = 0.001), l ymphadenopathy (31% vs. 11%; p less than or equal to 0.001), biliary tract abnormalities (25% vs. 12%; p less than or equal to 0.001), gut wall thicke ning (15% vs. 5%; p less than or equal to 0.001), and ascites (22% vs. 9%; p I 0.001). There were no differences in renal tract and pancreatic abnorma lities between the AIDS and HIV-groups. There were significantly fewer gall stones in the AIDS group (23% vs. 75%; p less than or equal to 0.001). Thes e patterns of abdominal US abnormalities were consistent across both hospit als. Conclusions: Diagnostic imaging by abdominal US is commonly used in the man agement of a variety of clinical indications in Central Africa, The changes seen on abdominal US in AIDS patients appear uniform across the two countr ies in Central Africa. These findings may have implications for the radiolo gist, especially in developing countries, where accurate microbiological or pathologic diagnosis of infectious and noninfectious diseases afflicting t he HIV-infected patient is often not possible and US is sometimes relied up on as a "diagnostic" investigation by many physicians. Further studies are required to define patterns of clinical findings, plain films, and patholog ic and laboratory correlates with US to develop and refine diagnostic algor ithms for clinical use in resource-poor countries.