Makinson Alain, Eymard-Duvernay Sabrina, Raffi François, Abgrall Sophie, Bommart Sébastien, Zucman David, Valour Florent, Cheret Antoine, Poizot-Martin Isabelle, Duvivier Claudine, Mauboussin Jean-Marc, Bonnet Fabrice, Tattevin Pierre, Reynes Jacques, Le Moing Vincent
aUniversity Montpellier, UMI233-IRD/U1175-INSERM, MontpellierbDepartment of Infectious and Tropical Diseases, Montpellier University Hospital, MontpelliercDepartment of Internal Medicine, Clinique Beau-Soleil, MontpellierdCMIT, PariseDepartment of Infectious Diseases and Tropical Medicine, AP-HP, Avicenne Hospital, BobignyfDepartment of Internal Medicine, AP-HP, Antoine Béclère Hospital, ClamartgDepartment of Medical Imaging, Lapeyronie Hospital, University Hospital Montpellier, MontpellierhPhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214 MontpellieriDepartment of HIV, AP-HP, Foch Hospital SuresnesjInfectious and Tropical Disease Unit, University Hospital de la Croix Rousse, LyonkDepartment of Infectious Diseases, Tourcoing Hospital, TourcoinglAix-Marseille University, APHM Sainte-Marguerite Hospital, Immuno-Hematology Clinic, MarseillemInserm U912 (SESSTIM), MarseillenEA 7327, Paris Descartes University-Sorbonne Paris Cité, ParisoDepartment of Infectious Diseases and Tropical Medicine, AP-HP, Necker-Enfants malades Hospital, Infectiology Centre Necker-Pasteur, ParispIHU Imagine, ParisqInfectious and Tropical Diseases Unit, Nîmes University Hospital, NîmesrDepartment of Internal Medicine and Infectious Diseases, University Hospital Bordeaux, INSERM U897, BordeauxsInfectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.
AIDS. 2016 Feb 20;30(4):573-82. doi: 10.1097/QAD.0000000000000943.
OBJECTIVE: Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers. DESIGN AND SETTING: French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012. PARTICIPANTS: 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. INTERVENTION: Single chest CT with a proposed standardized workup algorithm of positive images. MAIN OUTCOME MEASURE: The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up. RESULTS: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years. 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.
目的：对年龄在55至74岁的吸烟者进行胸部计算机断层扫描（CT）肺癌筛查是有益的。我们研究了在感染HIV的吸烟者中通过CT进行早期肺癌诊断的风险、益处和可行性。 设计与地点：2011年2月至2012年6月间在法国开展的一项法国多中心单轮胸部CT研究。 参与者：年龄至少40岁、吸烟史至少20包年、CD4 T淋巴细胞最低计数低于350个细胞/微升的HIV感染吸烟者。 干预措施：进行单次胸部CT检查，并采用针对阳性图像的标准化检查算法。 主要观察指标：结果是通过CT诊断并进行2年随访的经组织学证实的肺癌数量。 结果：纳入的442例患者的中位年龄为49.8岁，81.6%年龄在55岁以下，84%为男性，中位吸烟史为30包年，CD4细胞最低计数和最后计数的中位数分别为168和574个细胞/微升，90%的患者血浆HIV RNA低于50拷贝/毫升。94例（21%）患者在基线时有阳性图像，15例（3.4%）患者接受了18次侵入性检查，未发生严重不良事件。10例患者被诊断为肺癌（6例为早期），其中9例（2.0%，95%置信区间：0.9 - 3.8）通过CT检测出，8例为55岁以下患者。 结论：在感染HIV的吸烟者中通过CT进行早期肺癌诊断是可行、安全的，且发现了大量癌症病例。对有重要免疫缺陷病史的感染HIV的吸烟者进行肺癌筛查发现，与一般人群的目标范围相比，在更年轻的年龄段就发现了大量癌症病例。
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