title: Clinically significant incidental findings among human immunodeficiency virus-infected men during computed tomography for determination of coronary artery calcium.
abstract: Those infected with the human immunodeficiency virus (HIV) have a greater risk of cardiovascular disease and might undergo computed tomographic (CT) scans for early detection. Incidental findings on cardiac CT imaging are important components of the benefits and costs of testing. We determined the prevalence and factors associated with incidental findings on CT scans performed to screen for coronary artery calcium (CAC) among HIV-infected men. A clinically significant finding was defined as requiring additional workup or a medical referral. A total of 215 HIV-infected men were evaluated. Their median age was 43 years; 17% were current tobacco users; the median CD4 count was 580 cells/mm(3); and 83% were receiving antiretroviral medications. Also, 34% had a positive CAC score of >0. An incidental finding was noted among 93 participants (43%), with 36 (17%) having ≥1 clinically significant finding. A total of 139 findings were noted, most commonly pulmonary nodules, followed by granulomas, scarring, and hilar adenopathy. Most of the incidental findings were stable on follow-up, and no malignancies were detected. The factors associated with the presence of an incidental finding in the multivariate model included increasing age (odds ratio 1.6 per 10 years, p <0.01), positive CAC score (odds ratio 2.3, p <0.01), and current tobacco use (odds ratio 2.5, p = 0.02). In conclusion, incidental findings were common among HIV-infected men undergoing screening CT imaging for CAC determination. The incidental findings were more common among older patients and those with detectable CAC.
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA. nancy.crum@med.navy.mil
authors.forename: Nancy
authors.initials: N
authors.lastname: Crum-Cianflone
authors.forename: James
authors.initials: J
authors.lastname: Stepenosky
authors.forename: Sheila
authors.initials: S
authors.lastname: Medina
authors.forename: Dylan
authors.initials: D
authors.lastname: Wessman
authors.forename: David
authors.initials: D
authors.lastname: Krause
authors.forename: Gilbert
authors.initials: G
authors.lastname: Boswell
mesh_terms: D000328:Adult; D000465:Algorithms; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D042241:Early Diagnosis; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology