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Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening

Sigel, Keitha; Wisnivesky, Juana; Shahrir, Shahidab; Brown, Sheldon T.a,c; Justice, Amyd,e; Kim, Joonc; Rodriguez-Barradas, Maria C.f; Akgün, Kathleen M.d,e; Rimland, Davidg; Hoo, Guy W. Sooh; Crothers, Kristinab

doi: 10.1097/QAD.0000000000000189
Clinical Science

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).

Conclusion: 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.

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.

Correspondence to Dr Keith Sigel, MD, MPH. One Gustave Levy Place, New York, NY 10029, USA. Tel: +1 212 824 7558; fax: +1 917 210 4057; e-mail:

Received 24 October, 2013

Revised 18 December, 2013

Accepted 18 December, 2013

© 2014 Lippincott Williams & Wilkins, Inc.