Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy

In their article, Bonnet et al. recommend annual chest X-ray screening for lung carcinoma.1 Although some experts recommend a routine initial chest X-ray for patients infected with the human immunodeficiency virus for the detection of asymptomatic tuberculosis and to serve as a baseline study, to my knowledge guidelines do not include further follow-up radiography unless patients demonstrate symptoms, tuberculin test positivity, or an abnormal baseline radiograph.2 Among smokers without HIV infection, screening for lung carcinoma has not been demonstrated to decrease mortality from the disease, although it may result in diagnosis at an earlier, potentially resectable, stage of disease.3 I agree with Bonnet et al. that HIV-infected smokers are at an increased risk for lung carcinoma and I perform standard cancer screening tests in my HIV-infected patients. However, routine annual chest radiography will result in expense and complications from the testing and the interpretation of the radiographs and resultant workups. Given the lack of basic antiretroviral therapy in so many resource-poor settings worldwide and the absence of a proven benefit from annual chest radiography, I will await the outcomes of clinical trials of radiographic screening for lung carcinoma in HIV-seronegative patients and use that information to guide my practice.

Catherine Diamond M.D., M.P.H.*, * Department of Clinical Medicine, University of California Irvine, Orange, California.