title: Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers.
abstract: OBJECTIVE
  Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers.
  
  
  METHODS
  French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012.
  
  
  METHODS
  Patients were HIV-infected smokers at least 40 years, at least 20 pack-years, with a CD4 T-lymphocyte nadir count below 350 cells/μl.
  
  
  METHODS
  Single chest CT with a proposed standardized workup algorithm of positive images.
  
  
  METHODS
  The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up.
  
  
  RESULTS
  Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years.
  
  
  CONCLUSIONS
  Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general population.
authors.affiliation: aUniversity Montpellier, UMI233-IRD/U1175-INSERM, MontpellierbDepartment of Infectious and Tropical Diseases, Montpellier University Hospital, MontpelliercDepartment of Internal Medicine, Clinique Beau-Soleil, MontpellierdCMIT, PariseDepartment of Infectious Diseases and Tropical Medicine, AP-HP, Avicenne Hospital, BobignyfDepartment of Internal Medicine, AP-HP, Antoine Béclère Hospital, ClamartgDepartment of Medical Imaging, Lapeyronie Hospital, University Hospital Montpellier, MontpellierhPhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214 MontpellieriDepartment of HIV, AP-HP, Foch Hospital SuresnesjInfectious and Tropical Disease Unit, University Hospital de la Croix Rousse, LyonkDepartment of Infectious Diseases, Tourcoing Hospital, TourcoinglAix-Marseille University, APHM Sainte-Marguerite Hospital, Immuno-Hematology Clinic, MarseillemInserm U912 (SESSTIM), MarseillenEA 7327, Paris Descartes University-Sorbonne Paris Cité, ParisoDepartment of Infectious Diseases and Tropical Medicine, AP-HP, Necker-Enfants malades Hospital, Infectiology Centre Necker-Pasteur, ParispIHU Imagine, ParisqInfectious and Tropical Diseases Unit, Nîmes University Hospital, NîmesrDepartment of Internal Medicine and Infectious Diseases, University Hospital Bordeaux, INSERM U897, BordeauxsInfectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Makinson
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.forename: Sophie
authors.initials: S
authors.lastname: Abgrall
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bommart
authors.forename: David
authors.initials: D
authors.lastname: Zucman
authors.forename: Florent
authors.initials: F
authors.lastname: Valour
authors.forename: Antoine
authors.initials: A
authors.lastname: Cheret
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
authors.forename: Claudine
authors.initials: C
authors.lastname: Duvivier
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mauboussin
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
mesh_terms: D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*