title: Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening.
abstract: BACKGROUND
  HIV-infected persons have a two-fold to five-fold increased unadjusted risk of lung cancer. In the National Lung Screening Trial (NLST), computed tomography (CT) screening was associated with a reduction in lung cancer mortality among high-risk smokers. These results may not generalize to HIV-infected persons, particularly if they are more likely to have false-positive chest CT findings.
  
  
  METHODS
  We utilized data including standardized chest CT scans from 160 HIV infected and 139 uninfected Veterans enrolled between 2009 and 2012 in the multicenter Examinations of HIV Associated Lung Emphysema (EXHALE) Study. Abnormal CT findings were abstracted from clinical interpretations of the scans and classified as positive by NLST criteria vs. other findings. Clinical evaluations and diagnoses that ensued were abstracted from the medical record.
  
  
  RESULTS
  There was no significant difference by HIV in the proportion of CT scans classified as positive by NLST criteria (29% of HIV infected and 24% of HIV uninfected, P=0.3). However, HIV-infected participants with CD4 cell counts less than 200 cells/μl had significantly higher odds of positive scans, a finding that persisted in multivariable analysis. Evaluations triggered by abnormal CT scans were also similar in HIV-infected and uninfected participants (all P>0.05).
  
  
  CONCLUSIONS
  HIV status was not associated with an increased risk of abnormal findings on CT or increased rates of follow-up testing in clinically stable outpatients with CD4 cell count more than 200. These data reflect favorably on the balance of benefits and harms associated with lung cancer screening for HIV-infected smokers with less severe immunodeficiency.
authors.affiliation: aThe Icahn School of Medicine at Mount Sinai, New York, New York bUniversity of Washington School of Medicine, Seattle, Washington cJames J. Peters VA Medical Center, Bronx, New York dVA Connecticut Healthcare System, West Haven, Connecticut eYale University School of Medicine, New Haven, Connecticut fMichael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas gAtlanta VA Medical Center and Emory University School of Medicine, Atlanta, Georgia hVA Greater Los Angeles Healthcare System and Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
authors.forename: Shahida
authors.initials: S
authors.lastname: Shahrir
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Joon
authors.initials: J
authors.lastname: Kim
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Guy W Soo
authors.initials: GW
authors.lastname: Hoo
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D058345:Asymptomatic Infections; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed