Exploring the role of point-of-care ultrasound for people with HIV in a resource affluent setting: A prospective observational study

Background: In low resource settings point of care ultrasound (POCUS) has proven value for the detection of opportunistic diseases in HIV, especially tuberculosis. Few studies have explored POCUS in people with HIV and potential opportunistic infections in resource affluent settings.

Methods: We performed a prospective observational study in the Netherlands. Outpatients newly diagnosed with HIV and a CD4 T-cell count below 350 cells/mm³ and inpatients with HIV on the infectious diseases ward were included. POCUS of chest and abdomen were performed to detect opportunistic diseases and patients were followed for 1 year to register the presence or absence of opportunistic diseases as detected during routine care. Primary outcome was the number of HIV-related and unrelated conditions detected by POCUS and interobserver variation (ClinicalTrials.gov registration NCT04246983).

Results: We included 34 patients (79% males, median CD4 T-cell count 115/mm³). Observers had 97.5% agreement (Cohen's kappa for interobserver reliability 0.75). POCUS examination indicated at least one new opportunistic disease in 11 patients. In all these patients additional investigations confirmed opportunistic disease, predominantly Pneumocystis jirovecii pneumonia, bacterial pneumonia, Mycobacterium avium complex infection and lymphoma. In four patients an opportunistic disease was diagnosed in foci inaccessible for POCUS and a normal POCUS correctly excluded opportunistic diseases of the investigated structures in all patients, yielding a sensitivity of 73% and a specificity of 100%.

Conclusions: POCUS can be a reliable, valuable addition to physical examination of people with HIV and advanced immune suppression. The data support further exploration of POCUS in people with HIV in resource affluent settings.