Prospective CT screening for lung cancer in a high-risk population: HIV-positive smokers.
BACKGROUND
Epidemiological evidence suggests that HIV-infected individuals are at increased risk of lung cancer, but no data exist because large computed tomography (CT) screening trials routinely exclude HIV-infected participants.


METHODS
From 2006 to 2013, we conducted the world's first lung cancer screening trial of 224 HIV-infected current/former smokers to assess the CT detection rates of lung cancer. We also used 130 HIV-infected patients with known lung cancer to determine radiographic markers of lung cancer risk using multivariate analysis.


RESULTS
Median age was 48 years with 34 pack-years smoked. During 678 person-years, one lung cancer was found on incident screening. Besides this lung cancer case, 18 deaths (8%) occurred, but none were cancer related. There were no interim diagnoses of lung or extrapulmonary cancers. None of the pulmonary nodules detected in 48 participants at baseline were diagnosed as cancer by study end. The heterogeneity of emphysema across the entire lung as measured by CT densitometry was significantly higher in HIV-infected subjects with lung cancer compared with the heterogeneity of emphysema in those without HIV (p ≤ 0.01). On multivariate regression analysis, increased age, higher smoking pack-years, low CD4 nadir, and increased heterogeneity of emphysema on quantitative CT imaging were all significantly associated with lung cancer.


CONCLUSIONS
Despite a high rate of active smoking among HIV-infected participants, only one lung cancer was detected in 678 patient-years. This was probably because of the young age of participants suggesting that CT screening of high-risk populations should strongly consider advanced age as a critical inclusion criterion. Future screening trials in urban American must also incorporate robust measures to ensure HIV patient compliance, adherence, and smoking cessation.
Departments of *Oncology, †Surgery, ‡Medicine, Infectious Diseases, §Radiology, ‖Pulmonology, ¶Medicine, and #Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Alicia
A
Hulbert
Craig M
CM
Hooker
Jeanne C
JC
Keruly
Travis
T
Brown
Karen
K
Horton
Eliott
E
Fishman
Kristen
K
Rodgers
Beverly
B
Lee
Celis
C
Sam
Salina
S
Tsai
Elizabeth
E
Weihe
Genevieve
G
Pridham
Brad
B
Drummond
Christian
C
Merlo
Maria
M
Geronimo
Michelle
M
Porter
Solange
S
Cox
Dan
D
Li
Marian
M
Harline
Mario
M
Teran
John
J
Wrangle
Beatrice
B
Mudge
Gregory
G
Taylor
Gregory D
GD
Kirk
James G
JG
Herman
Richard D
RD
Moore
Robert H
RH
Brown
Malcolm V
MV
Brock
D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D055088:Early Detection of Cancer; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed