Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ cell count at least 500 cells/μl

被引:0
作者
Kong, Chung Yin [1 ,2 ]
Sigel, Keith [3 ]
Criss, Steven D. [1 ]
Sheehan, Deirdre F. [1 ]
Triplette, Matthew [9 ]
Silverberg, Michael J. [5 ]
Henschke, Claudia I. [4 ]
Justice, Amy [6 ,7 ]
Braithwaite, R. Scott [8 ]
Wisnivesky, Juan [3 ]
Crothers, Kristina [9 ]
机构
[1] Massachusetts Gen Hosp, Inst Technol Assessment, 101 Merrimac St,10th Floor, Boston, MA 02114 USA
[2] Harvard Med Sch, Boston, MA USA
[3] Icahn Sch Med Mt Sinai, Div Gen Internal Med, New York, NY 10029 USA
[4] Icahn Sch Med Mt Sinai, Dept Radiol, New York, NY 10029 USA
[5] Kaiser Permanente, Div Res, Oakland, CA USA
[6] VA Connecticut Healthcare Syst, New Haven, CT USA
[7] Yale Univ, Sch Med, West Haven, CT 06516 USA
[8] NYU, Dept Populat Hlth, New York, NY USA
[9] Univ Washington, Sch Med, Dept Med, Seattle, WA 98195 USA
关键词
AIDS; HIV; lung cancer; population health; public health; smoking; CHEST COMPUTED-TOMOGRAPHY; ANTIRETROVIRAL THERAPY; LIFE EXPECTANCY; UNINFECTED INDIVIDUALS; CIGARETTE-SMOKING; RISK; MORTALITY; POPULATION; IMMUNODEFICIENCY; PEOPLE;
D O I
10.1097/QAD.0000000000001818
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. Design: We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. Data sources: Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. Target population: HIV-infected current and former smokers. Time horizon: Lifetime. Perspective: Population. Intervention: Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. Main outcome measures: Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. Results of base-case analysis: For HIV-infected patients with CD4(+) cell count at least 500 cells/mu l and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. Limitations: Strategies assumed 100% screening adherence. Conclusion: Lung cancer screening reduces mortality in HIV-infected patients with CD4(+) cell count at least 500 cells/mu l, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria. Copyright (C) 2018 The Author(s). Published by Wolters Kluwer Health, Inc.
引用
收藏
页码:1333 / 1342
页数:10
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