title: Chest Low-Dose Computed Tomography for Early Lung Cancer Diagnosis as an Opportunity to Diagnose Vertebral Fractures in HIV-Infected Smokers, an ANRS EP48 HIV CHEST Substudy.
abstract: BACKGROUND
  To estimate the prevalence of vertebral fractures on chest low-dose computed tomography (LDCT) in HIV-infected smokers.
  
  
  METHODS
  Cross-sectional study of vertebral fractures visualized on chest LDCT from a multicenter prospective cohort evaluating feasibility of chest LDCT for early lung cancer diagnosis in HIV-infected subjects. Subjects were included if 40 years or older, had been active smokers within the last 3 years of at least 20 pack-years, and had a CD4 T-lymphocyte nadir cell count <350 per microliter and an actual CD4 T-cell count >100 cells per microliter. Spinal reconstructed sagittal planes obtained from chest axial native acquisitions were blindly read by a musculoskeletal imaging specialist. Assessment of the fractured vertebra used Genant semiquantitative method. The study end point was the prevalence of at least 1 vertebral fracture.
  
  
  RESULTS
  Three hundred ninety-seven subjects were included. Median age was 49.5 years, median smoking history was 30 pack-years, median last CD4 count was 584 cells per microliter, and median CD4 nadir count was 168 cells per microliter; 90% of subjects had a viral load below 50 copies per milliliter. At least 1 fracture was visible in 46 (11.6%) subjects. In multivariate analysis, smoking ≥40 packs-years [OR = 2.5; 95% CI: (1.2 to 5.0)] was associated with an increased risk of vertebral fracture, while HIV viral load <200 copies per milliliter [OR = 0.3; 95% CI: (0.1 to 0.9)] was protective.
  
  
  CONCLUSIONS
  Prevalence of vertebral fractures on chest LDCT was 11.6% in this high-risk population. Smoking cessation and early introduction of antiretroviral therapy for prevention of vertebral fractures could be beneficial. Chest LDCT is an opportunity to diagnose vertebral fractures.
authors.affiliation: *Department of Medical Imaging, Lapeyronie Hospital, University Montpellier, Montpellier, France; †Department of Infectious and Tropical Diseases, University Montpellier, Montpellier, France; ‡UMI 233, IRD, University Montpellier, Montpellier, France; §Department of Internal Medicine, Clinique Beau-Soleil, Montpellier, France; ‖Department of Medical Imaging, University Hospital Pontchaillou, Rennes, France; ¶Department of Medical Imaging, University hospital Hôtel Dieu, Nantes, France; #Department of Medical Imaging, University Hospital Haut Lévèque, Bordeaux, France; **Department of Medical Imaging, University Hospital Necker-Enfants Malades, Paris, France; and ††UPRES EA 2363, Sorbonne Paris Cité, University Paris 13; Department of Medical Imaging, University Hospital Avicenne, Bobigny, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Thouvenin
authors.forename: Alain
authors.initials: A
authors.lastname: Makinson
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: Pierre
authors.initials: P
authors.lastname: Lentz
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Delemazure
authors.forename: Olivier
authors.initials: O
authors.lastname: Corneloup
authors.forename: Sylvie
authors.initials: S
authors.lastname: Fabre
authors.forename: Mylène
authors.initials: M
authors.lastname: Quesnoy
authors.forename: Sylvain
authors.initials: S
authors.lastname: Poire
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Brillet
authors.forename: Catherine
authors.initials: C
authors.lastname: Cyteval
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D049669:History, 16th Century; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects*; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D013131:Spine / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*