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

来源：

AIDS | 2018年 / 32卷 / 10期

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

页码：1333 / 1342

页数：10