Screening and noninvasive testing for pulmonary disease

Although detection of preclinical disease using screening tests is desirable if earlier treatment improves outcome, the available data show no morbidity or mortality benefit using chest radiography, sputum analysis for Pneumocystis carinii and acid-fast bacilli, or serial measurements of single-breath carbon monoxide diffusing capacity to detect pulmonary disease in asymptomatic persons with HIV. It seems prudent to evaluate asymptomatic patients periodically with a careful history and focused physical examination and to perform only those tests that are likely to alter the plan of management such as tuberculin skin testing, CD4 lymphocyte measurement, and measurement of viral burden. Noninvasive diagnostic studies including chest radiography, arterial blood gas analysis, induced or expectorated sputum analysis, exercise testing, and nuclear scans should be performed if new pulmonary symptoms are observed. The use of these tests should be guided by the clinical presentation and followed, when necessary, by the appropriate invasive studies.