Role and interpretation of fluorodeoxyglucose-positron emission tomography/computed tomography in HIV-infected patients with fever of unknown origin: a prospective study
Article first published online: 20 MAR 2013
© 2013 British HIV Association
Volume 14, Issue 8, pages 455–462, September 2013
How to Cite
Martin, C., Castaigne, C., Tondeur, M., Flamen, P. and De Wit, S. (2013), Role and interpretation of fluorodeoxyglucose-positron emission tomography/computed tomography in HIV-infected patients with fever of unknown origin: a prospective study. HIV Medicine, 14: 455–462. doi: 10.1111/hiv.12030
- Issue published online: 1 AUG 2013
- Article first published online: 20 MAR 2013
- Manuscript Accepted: 24 JAN 2013
- fever of unknown origin;
- positron emission tomography/computed tomography;
The aim of the study was to evaluate prospectively the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in investigation of fever of unknown origin (FUO) in HIV-positive patients and to determine whether HIV viraemia impacts on FDG-PET/CT performance.
The FDG-PET/CT results of 20 HIV-infected patients with FUO were analysed and compared with the FDG-PET/CT results of 10 HIV-infected viraemic patients without FUO. The performance of FDG-PET/CT for identifying the aetiology of FUO was assessed. Final diagnosis for FUO was based on histopathology, microbiological assays, or clinical and imaging follow-up.
FDG-PET/CT contributed to the diagnosis or exclusion of a focal aetiology of the febrile state in 80% of patients with FUO. The presence of increased FDG uptake in the central lymph node has 100% specificity for focal aetiology of fever, even in viraemic patients. The absence of hypermetabolic central lymph nodes in FUO patients has 100% negative predictive value for focal disease. Lymph node biopsy in central hypermetabolic areas allowed, in 100% of cases, identification of underlying disease in patients with FUO. Biopsy of peripheral lymph nodes should be performed in lymph nodes with maximum standardized uptake value (SUVmax) ≥ 6–8 (sensitivity 62.5%; specificity 75%) and avoided in lymph nodes with SUVmax = 0–4 (specificity 0%). High HIV viraemia does not prevent correct interpretation of FDG-PET/CT.
As in HIV-negative patients, we confirm the usefulness of FDG-PET/CT in investigation of FUO in HIV-positive patients even if they are viraemic.