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Incidental findings on chest computed tomography are common and linked to inflammation in HIV-infected adults.

ABSTRACT: Chest imaging is performed for a variety of reasons in HIV-infected adults. There are limited data on the prevalence of incidental findings, progression of these findings over time and the relationship with inflammation in antiretroviral therapy (ART)-treated HIV-infected adults.This study utilized data from a randomized clinical trial of rosuvastatin in HIV-infected adults on ART. Incidental findings were reported from chest computed tomography (CT) scans obtained for coronary artery calcium score at entry, week 48 and 96. Markers of immune activation and inflammation were measured concurrently. Poisson regression and generalized estimating equations were used.A total of 147 participants were enrolled. Median age was 46 years, 78% were male, 68% African American and 63% current smokers. At baseline, 57% of participants had at least one incidental lung finding (ILF) and four additional participants had at least one ILF by week 96. At baseline, older age, current smoking, lower nadir CD4+ T-cell count and low-density lipoprotein and higher lipoprotein-associated phospholipase A2 (Lp-PLA2) were independently associated with having a greater number of ILFs. In the longitudinal analyses, older age, lower nadir CD4+ T-cell count and higher baseline soluble tumour necrosis factor ?-receptor I (sTNF-RI) were independently associated with having a greater number of ILFs over 96 weeks.Over half of participants had at least one incidental finding on chest CT. Beyond traditional factors of older age and smoking, lower nadir CD4+ T-cell count and higher markers of inflammation were associated with having a greater number of ILFs in HIV-infected adults on ART.

SUBMITTER: Park MS

PROVIDER: S-EPMC5484045 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Incidental findings on chest computed tomography are common and linked to inflammation in HIV-infected adults.

Park Michelle S MS Hileman Corrilynn O CO Sattar Abdus A Gilkeson Robert R McComsey Grace A GA

Antiviral therapy 20160924 2

<h4>Background</h4>Chest imaging is performed for a variety of reasons in HIV-infected adults. There are limited data on the prevalence of incidental findings, progression of these findings over time and the relationship with inflammation in antiretroviral therapy (ART)-treated HIV-infected adults.<h4>Methods</h4>This study utilized data from a randomized clinical trial of rosuvastatin in HIV-infected adults on ART. Incidental findings were reported from chest computed tomography (CT) scans obta ...[more]

PMID: 27647021

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Project description:BackgroundCoronary artery calcium (CAC) can be identified on nongated chest computed tomography (CT) scans, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of nongated chest CT scans. Our objective was to evaluate the effect of notifying clinicians and patients of incidental CAC on statin initiation.MethodsNOTIFY-1 (Incidental Coronary Calcification Quality Improvement Project) was a randomized quality improvement project in the Stanford Health Care System. Patients without known atherosclerotic cardiovascular disease or a previous statin prescription were screened for CAC on a previous nongated chest CT scan from 2014 to 2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomly assigned to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months.ResultsAmong 2113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After chart review and additional exclusions were made, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomly assigned to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (P<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] versus 2.3% [2/87]; P=0.008).ConclusionsOpportunistic CAC screening of previous nongated chest CT scans followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce atherosclerotic cardiovascular disease events.RegistrationURL: https://www.Clinicaltrialsgov; Unique identifier: NCT04789278.

Dataset Information

Incidental findings on chest computed tomography are common and linked to inflammation in HIV-infected adults.

Publications

Incidental findings on chest computed tomography are common and linked to inflammation in HIV-infected adults.

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