Ultrasound may help screen for interstitial lung disease in HIV-positive patients

Ultrasound appears to provide a fast, reliable, and sensitive point-of-care tool for detecting interstitial lung disease among HIV-positive patients, according to a study. However, ultrasound falls short of differentiating between different disease aetiologies.

The researchers assessed the ability of lung ultrasound vs radiography and computed tomography (CT) imaging for detection of HIV-related lung diseases. Three raters evaluated ultrasound examinations in HIV-positive patients, while a single rater assessed available conventional imaging data. Results were compared with each other and to the definite diagnosis, with inter-rater reliability computed for each finding.

A total of 80 HIV-positive patients received lung ultrasound examinations, while 74 underwent conventional imaging. The overall sensitivity was 97.5 percent for CT, 90.7 percent for ultrasound, and 78.1 percent for radiography.

Pneumocystis jirovecii pneumonia and bacterial pneumonia were the most common diagnoses, seen in 21 and 17 patients, respectively. On the other hand, interstitial abnormalities were the most frequent and sensitive ultrasonographic findings, as indicated by B-Lines, independent of the aetiology.

Inter-rater reliability was high for interstitial abnormalities (average-weighted intraclass correlation, 0.82). Meanwhile, the inter-rater reliability for consolidations and effusion improved during the study (r=0.88 and r=0.37, respectively).

The present data demonstrate that ultrasound provides quick results. The fast availability at the patients’ bedside, its sensitivity, and absence of radiation can help pinpoint which patients need exposure to further diagnostics. This should spare other patients from irradiation when sonography provides sufficient diagnostic data and may accelerate diagnostics in critical conditions until reaching a final confirmation, according to the researchers.