Clinical, Radiologic Features Help to Distinguish Pulmonary Infections From Lung Cancers in Patients With HIV

Individuals with HIV are often susceptible to opportunistic pulmonary infections (OPIs), but the lung lesions resulting from these infections can be mistaken for lung cancer, according to a new study that aimed to characterize features of OPIs versus tumors in patients with HIV.

The study, published in Journal of Thoracic Disease, used a hospital’s sample of radiologic scans from 24 patients with HIV who were misdiagnosed with lung cancers based on computed tomography (CT) imaging, then had an OPI diagnosis confirmed by pathological testing or a combination of clinical/laboratory results. The study also included 49 patients with HIV and confirmed lung cancer as a control group.

Of the 24 patients with OPIs, 19 (79.2%) had tuberculosis infections, 2 (8.3%) had nontuberculosis mycobacterium (NTM) infections, 2 (8.3%) had streptococcus infections, and 1 (4.2%) had a mixed infection of tuberculosis and NTM. These patients tended to be younger than those who were correctly diagnosed with lung cancer (median age, 41 vs 58 years, respectively) and were less likely to be smokers (8.3% vs 36.7%). The patients with OPIs had a significantly shorter duration of time on highly active antiretroviral therapy compared with the patients with cancer (median [interquartile range], 0 [0-0.2] vs 8 [0-32] months).

From CT imaging, the researchers did not find differences in CT signs of central-type lesions between the OPI and cancer groups, but there were some differences in the features of peripheral-type lesions: Patients with OPI were more likely to have satellite lesions (P = .020) and less likely to have pleural indentation (P = .016) than patients with cancer. When assessing CT images using radiomics, which decodes the intrinsic heterogeneity of a lesion, the researchers found that 4 radiomic parameters of central-type lesions were significantly different between the OPI and cancer groups, whereas there were no significant differences found for peripheral-type lesions.

The study was conducted in a hospital in China, where the epidemiological patterns of HIV infection are changing, according to the study authors. Their finding that most patients with OPIs were younger and were diagnosed with HIV without starting antiretroviral therapy may have been related to rising rates of HIV among migrant populations working in developing regions, who often face barriers to accessing healthcare.

“Clinicoradiologic characteristics together with radiomic features may help identify OPIs mimicking lung cancers in HIV-infected patients,” the study authors concluded. “The initial application of CT radiomics in OPIs and cancers may provide added diagnostic value for differentiation, especially in central-type lesions.”

They suggested that future research using larger sample sizes collected from multiple clinics could help further improve the accuracy of diagnosis for individuals with HIV.

Reference

Shi W, Zhou L, Peng X, et al. HIV-infected patients with opportunistic pulmonary infections misdiagnosed as lung cancers: the clinicoradiologic features and initial application of CT radiomics. J Thorac Dis. 2019;11(6):2274-2286. doi: 10.21037/jtd.2019.06.22.