Abdominal CT features and survival in acquired immunodeficiency

Purpose: HIV-infected patients show a high incidence of abdominal disease. This investigation was made to determine whether abdominal CT provided prognostically relevant information in these patients. Material and Methods: Images from 533 abdominal CT examinations in 339 HIV-infected patients were retrospectively reviewed for signs of abdominal disease, and correlated with clinical data and survival rates. The Kaplan-Meier analysis and rank testing of survival, and proportional hazards regression were used to define prognostic clinical and imaging findings. Results: Of the 339 patients, 278 (82%) showed abnormal abdominal findings on CT. Median survival was 29 months. Of the imaging findings, hepatic masses (n=11), pathologically enlarged lymph nodes (n=48), and ascites (n=7) were associated with poor survival, giving a median survival of respectively 13 months, 15 months, and less than 1 month. These three features showed no association with CD4⁺-T-lymphocyte count or CDC category. Main determinants of survival were a low CD4⁺-T-lymphocyte count, and certain abnormal CT findings. Splenomegaly (n=147), hepatomegaly (n=144), and lymphadenopathy (n=111) were the most common abdominal findings on CT but lacked prognostic relevance. Conclusion: Abdominal CT offered prognostic implications in HIV-infected patients and might serve in risk stratification in selected patients. CT features such as hepatic masses, grossly enlarged lymph nodes, or ascites indicate advanced immunosuppression.