Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening

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Abstract

Objective:

Lung cancer screening may benefit HIV-infected (HIV+) smokers because of an elevated risk of lung cancer, but may have unique harms because of HIV-specific risk factors for false-positive screens. This study seeks to understand whether inflammatory biomarkers and markers of chronic lung disease are associated with noncalcified nodules at least 4 mm (NCN) in HIV+ compared with uninfected patients.

Design:

This is a cohort study of Examinations of HIV-Associated Lung Emphysema (EXHALE), including 158 HIV+ and 133 HIV-uninfected participants.

Methods:

Participants underwent a laboratory assessment [including measurement of D-dimer, interleukin 6, and soluble CD14 (sCD14)], chest computed tomography (CT), and pulmonary function testing. We created multivariable logistic regression models to determine predictors of NCN in the participants stratified by HIV status, with attention to semiqualitative scoring of radiographic emphysema, markers of pulmonary function, and inflammatory biomarkers.

Results:

Of the 291 participants, 69 had NCN on chest CT. As previously reported, there was no difference in prevalence of these nodules by HIV status. Emphysema and elevated sCD14 demonstrated an association with NCN in HIV+ participants independent of smoking status, CD4+ cell count, HIV viral load, and pulmonary function.

Conclusion:

Emphysema and sCD14, a marker of immune activation, was associated with a higher prevalence of NCN on chest CT in HIV+ participants. Patients with chronic immune activation and emphysema may be at higher risk for both false-positive findings and incident lung cancer, thus screening in this group requires further study to understand the balance of benefits and harms.

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