Low-Dose Computed Tomography (LDCT) screening has shown to decrease mortality in at-risk individuals. While HIV-infected individuals exhibit approximately a two-fold higher risk of lung cancer compared to the general population, the role of LDCT in this population remains controversial. We report the results of a lung screening program with LDCT in HIV-infected individuals.
HIV-infected individuals on follow-up in a tertiary hospital were offered LDCT for lung cancer screening. Inclusion criteria were: 45 years or years or older, 30 pack-year history of smoking, quit smoking in the previous 15 years, and absence of previous lung cancer diagnosis. We registered the following radiological data: presence of lung nodules, pathological lymph nodes, coronary atherosclerosis, aortic dilatation, bone marrow attenuation, lung emphysema, and non-nodular lung opacities.
A total of 141 patients underwent LDCT of whom 86% were men and 14% were women. The median age was 57 years (54-60), 87 (62 %) had positive HCV antibodies, median nadir CD4 count was 179 (75-305), current CD4 count was 666 (403-911), HIV RNA count <20 copies/mL in 138 (97.1%) subjects. The median pack-year was 34 (25-41), 122 (82%) were active smokers. Radiological abnormalities were common, including pulmonary emphysema in 90 patients (64%), lung non-nodular opacities in 29 (21%), lymph nodes >1cm in 10 (7%), aortic dilation in 4 (2.8%), and radiological bone marrow attenuation in 21 (15%). Lung nodules were found in 52 subjects (37%); <4mm in 21 (15%), 4-8mm in 18 (13%) and >8mm in 13 (9%).
Lung cancer was diagnosed in 5 cases, yielding a prevalence of 3.6%. Histological examination revealed 4 cases of squamous cell carcinoma and 1 adenocarcinoma. Compared to the rest of our cohort, patients with lung cancer were of similar age (56.5 [53.5-59.5] years), had a lower CD4 nadir count (71 [4-105] cells/uL), lower current CD4 counts (352 [242-517] cells/uL), and higher median pack-year (71 [50-91]).
In this program of lung cancer screening with LDCT in HIV-infected individuals we found a high prevalence of lung cancer (3.6%). These results indicate that people living with HIV with additional risk factors for lung cancer are a target population for screening programs.