CT imaging of HIV-associated pulmonary disorders in COVID-19 pandemic

Opportunistic infections in people living with human immunodeficiency virus (HIV) are readily detected with thoracic computed tomography (CT), but differential diagnosis remains a challenge. The global COVID-19 pandemic further exacerbates the issue, with SARS-CoV-2 having overlapping CT findings with infections common in HIV patients and complicating prior epidemiological data. We present a pictorial review of CT findings associated with COVID-19-mimicking opportunistic infections that can be encountered in HIV patients. PubMed database was searched for the complete list of relevant conditions, and a Venn diagram was constructed to highlight overlapping entities. The diagram showed five major disease groups: viral pneumonia, fungal pneumonia, bacterial pneumonia, sarcoidosis, and lung cancer. As these pathologies possess a wide range of features, the findings were grouped as “typical” and “other” for easier comprehension with provided relevant epidemiological data and discrepancies observed in available literature. The review highlights the importance of a specific approach to differential diagnosis in immunocompromised patients compared to immunocompetent hosts and the utility of follow-up scans.