HIV patients who undergo lung cancer screening would have reductions in mortality similar to those seen in people without HIV, according to a simulation study.
“Lung cancer screening with LDCT (low-dose computed tomography) among HIV-infected smokers appears to provide similar mortality reduction as in the general population and HIV-infected persons with CD4+ cell count of at least 500 should be considered candidates for lung cancer screening as programs are implemented,” Dr. Chung Yin Kong of the Institute for Technology Assessment at Massachusetts General in Boston and colleagues write in AIDS, online April 19.
Lung cancer is the most frequent non-AIDS-defining cancer (NADCs) in people with HIV, and the leading killer among NADCs, the researchers note. The Centers for Medicare & Medicaid Services (CMS) covers lung-cancer screening with LDTC for people aged 55-77 with at least 30 pack-years of smoking, who either still smoke or quit within the last 15 years.
While these high-risk individuals have a 20% reduction in lung-cancer mortality with LDTC, the authors say, “HIV-infected persons were not included in these prior studies or guideline recommendations. Therefore, considerable uncertainty exists regarding the appropriateness of lung cancer screening for HIV-infected persons.”
The researchers tailored the Lung Cancer Policy Model (used to develop the U.S. Preventive Services Task Force’s lung-cancer-screening recommendations) to people with HIV. In a simulated population of HIV-negative people and HIV-positive individuals with CD4+ counts of 500 or above, screening would reduce mortality by 10.8% and 7.7%, respectively, the authors found.
When only screened individuals were analyzed, the reductions in mortality were 22.7% and 18.9%, respectively.
Screening 45- to 77-year-olds with at least 20 pack-years would produce the greatest increase in life years, but would also require the highest number of LDCT scans to be performed and lead to the most overdiagnosis.
Given the shorter life expectancy of people with HIV, the authors note, “lowering the screening termination age from 77 to 72 might be an alternative way to screen these patients for lung cancer, as this strategy was also on the frontier and produced a similar mortality reduction with fewer LDCT scans obtained. Our findings highlight the importance of considering both benefits and harms of screening in considering optimal screening strategies.”
Dr. Kong was not available for an interview by press time.