Study objectives: To determine the etiology and the
clinical and radiographic predictors of the etiology of pulmonary
nodules in a group of HIV-infected patients.
Setting: A large urban
hospital in San Francisco, CA.
patients evaluated at San Francisco General Hospital from June 1, 1993,
through December 31, 1997, having one or more pulmonary nodules on
Main outcome measures: Three physicians
reviewed medical records for clinical data and final diagnoses. Three
chest radiologists blinded to clinical data reviewed chest CTs.
Univariate and multivariate analyses were performed to determine
clinical and radiographic predictors of having an opportunistic
infection and the specific diagnoses of bacterial pneumonia and
Results: Eighty seven of 242 patients
(36%) had one or more pulmonary nodules on chest CT. Among these 87
patients, opportunistic infections were the underlying etiology in 57
patients; bacterial pneumonia (30 patients) and tuberculosis (14
patients) were the most common infections identified. Multivariate
analysis identified fever, cough, and size of nodules < 1 cm on chest
CT as independent predictors of having an opportunistic infection.
Furthermore, a history of bacterial pneumonia, symptoms for 1 to 7
days, and size of nodules < 1 cm on CT independently predicted a
diagnosis of bacterial pneumonia; a history of homelessness, weight
loss, and lymphadenopathy on CT independently predicted a diagnosis of
Conclusions: In HIV-infected patients
having one or more pulmonary nodules on chest CT scan, opportunistic
infections are the most common cause. Specific clinical and
radiographic features can suggest particular opportunistic