Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. The authors studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers.
A multicentre, single round chest CT study was conducted in France, between February 2011 and June 2012. 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. Single chest CT was performed with a proposed standardized workup algorithm of positive images. Main outcome measure was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up.
Of the 442 included patients, median age was 49.8 years, 81.6% were < 55 years, 84% were men, median smoking was 30 pack-years and 35% had a history of cannabis use. Median nadir and last CD4 + cell counts were 168 and 574 cells/µl, respectively, 98% patients were on cART, for a median duration of 13.8 years, and 90% had a plasma HIV RNA < 50 copies/ml.
A positive image (significant nodule, adenopathy or endobronchial image) at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Median follow-up time after CT was 24.4 months (IQR of 22.8 to 26.4 months). After the 442 baseline CTs, 54 patients (12%) had a second, 22 (5%) a third, 16 (4%) a fourth or fifth, and two (0.5%) a sixth protocol CT for follow-up of positive images.
A total of 10 lung cancers were diagnosed, amongst which nine (2.03%, 95% confidence interval: 0.9–3.8) had been visualized as positive nodules on baseline CT. Of these nine patients, eight had histologically proven lung cancers (seven of which were adenocarcinomas, and one a squamous cell carcinoma), and an additional female patient had a highly probable lung cancer suspected on a 10-mm nodule. 8/10 patients were < 55 years. The number of patients needed to detect one lung cancer with the CT procedure was 49 (95% CI: 26–111).
In conclusion, 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.
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