The prevalence and radiological findings of pulmonary embolism in HIV-positive patients referred for computed tomography pulmonary angiography in the Western Cape of South Africa

Abstract

SummaryAim:To provide imaging data and report associations between human immunodeficiency virus (HIV), tuberculosis (TB) and pulmonary embolism (PE) in a South African population that underwent computed tomography pulmonary angiography (CTPA) for suspected PE.Methods:A validated Qanadli severity scoring system for PE was used for 164 CTPA scans, and parenchymal, pleural and cardiovascular complications were reported. Serological confirmation of HIV testing and microbiological confirmation of TB were recorded.Results:Prevalence of PE in the CTPA population was 26% (95% CI: 19.67–33.65%). HIV-positive prevalence in patients with PE was 67% (95% CI: 48.17–82.04%), however it was not statistically significantly different when compared with the patients without PE (p = 1). HIV-positive patients had more extensive partial thrombus in the right middle lobe (p = 0.045), but no other differences when compared with HIV-negative patients. TB prevalence in patients with PE was 57% (95% CI: 34.49–76.81%). This was statistically significantly different when compared with the patients without PE (p = 0.073 at the 10% level). Prevalence of TB co-morbidity in the HIV-positive group with proven PE was 71% (95% CI: 41.90– 91.61%), however there was no statistically significant difference in comparison with the HIV-negative patients with TB and PE (p= 0.305).Conclusion:The high number of patients presenting for CTPA who were HIV infected (and also infected with TB) highlights that PE evaluation should include severity/extent of the disease, as these patients may have more severe disease in specific lung lobes. The use of a validated scoring system, such as the Qanadli score, when reporting PE may have a profound effect on patient risk stratification, management and prognosis and would also provide a system for collecting larger volumes of data for analysis.

CT pulmonary angiography findings in HIV-infected patients referred for suspected pulmonary thrombo-embolic disease

“…Pleural effusion was present in 57% of the PE-positive cases in this study. This is higher than the 45% in the study on HIVinfected patients by Ramlakhan et al 11 , as well as higher than the 25.8% in the study by Sharma et al 14 studies carried out on both HIV-infected and -negative populations. 7,11,14 These findings are traditionally thought to be due to PE.…”

“…5,6,7,9 This is in keeping with other literature on HIV-infected patients where the mean ages for PE were younger than the general population, ranging from 40 to 45 years. 2,3,10,11,12 Presenting symptoms in this study were typical of that described in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED II) trial, including shortness of breath, syncope, chest pain and haemoptysis -all of which are non-specific. 13 The CTPA prevalence of PE in an HIV-infected study population in this study was found to be 35%.…”

“…15 This was echoed in a South African analysis, where lower lobes were also more commonly affected compared with upper lobes in HIV-infected patients. 11 We reported the RLL to be most affected (20%) with a near even distribution of PE within the other lobes (Table 2), the reasons for this not being clear.…”

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

“…While chronic obstructive pulmonary disease and pulmonary hypertension secondary to left-sided heart failure are seen in all settings, chronic fibrocavitary TB is a frequent underlying cause in Africa [42]. In addition, HIV, schistosomiasis, and pulmonary embolism can lead to chronic pulmonary hypertension eventually resulting in cor pulmonale [43,44]. Moreover, patients with HIV may suffer from HIV-associated pulmonary artery hypertension.…”

Clinical and Demographic Predictors of Acute Pulmonary Embolism in Central Africa Using 64-Rows Multi-Detector Computed Tomography Angiography

“…Recently, the first case of PE associated with malaria was documented in Kampala (Musoke et al, 2014). And the association of PE with HIV/AIDS infection and with tuberculosis have been described (Ekukwe, 2014;Ramlakhan et al, 2017;Park et al, 2017;Gupta et al, 2017).…”