In the May 2002 issue of CHEST, Gold et al1–
published an intriguing manuscript reviewing the significance of abnormal chest radiographic findings in HIV-1-infected individuals who did not have specific respiratory symptoms. However, we disagree with several statements, particularly those supporting the use of screening chest radiography. Comparisons with the pulmonary complications of HIV infection study of screening chest radiography are not applicable.2
Gold et al1
studied hospitalized patients with constitutional or other symptoms and abnormal chest radiograph findings who were referred for pulmonary consultation. Reviews were of the consultation service ledger rather than of the entire patient record, and pulmonary symptoms may have been missed. Their patients were symptomatic, so the radiographs were not screening studies. Rather, radiographs of patients who are febrile, losing weight, or have extrapulmonary disease are diagnostic tests. In the broadest sense, radiographs in HIV-infected persons who have been admitted to the hospital for other reasons should be considered case-finding studies, not screening studies.