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Grant Details

Grant Number: 5R01CA173754-05 Interpret this number
Primary Investigator: Crothers, Kristina
Organization: University Of Washington
Project Title: Benefits and Harms of Lung Cancer Screening in HIV Infection
Fiscal Year: 2017
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Abstract

DESCRIPTION (provided by applicant): Lung cancer is the most common non-AIDS defining cancer (NADC) and leading source of NADC mortality amongst HIV infected (HIV+) individuals. HIV+ persons have a greater burden of lung cancer due to higher smoking rates combined with an independent HIV related increased risk of lung cancer. Unfortunately, most lung cancers are clinically diagnosed at an advanced stage and have 5-year survival rates <15%. Earlier detection strategies to improve lung cancer mortality among HIV+ persons are urgently needed. The National Lung Screening Trial (NLST) recently demonstrated that low-dose screening chest computed tomography (CT) led to a 20% reduction in lung cancer mortality among high-risk, HIV uninfected (HIV-) smokers. As a result, lung cancer screening is now recommended by the National Comprehensive Cancer Network for high-risk smokers. Extrapolating results of the NLST to HIV+ individuals is challenging. The increased risk and burden of lung cancer in this aging population would make HIV+ persons excellent candidates for screening. However, HIV+ persons also experience considerable multimorbidity and can have higher mortality from competing risks. Thus, how to apply results of the NLST to HIV+ persons is unclear, as some patients may not survive long enough to derive benefits of screening. Additionally, HIV+ persons may be more likely to have false positive CT scans due to prior lung disease and immunocompromise. Consequently, the morbidity associated with the work-up of benign nodules, which are quite common, could be significant. Given that an RCT limited to HIV+ patients is very unlikely in the near future, we propose to develop a mathematical model that estimates the potential benefits of screening, identifies the appropriate candidates for screening, and determines the best screening regimen. As the health care burden of screening CT can be substantial, we will first determine the clinical consequences that result from performing screening chest CT scans among HIV+ individuals by analyzing results of CT scans and data from a large cohort study. Then, we will construct a model to estimate the impact of lung cancer screening on mortality among HIV+ persons; we will compare this model and its results to one generated by our collaborators in the NCI-funded Cancer Intervention and Surveillance Modeling Network (CISNET). After base case analyses, we will consider screening in different HIV+ populations, mortality from competing causes, and the optimal regimen and age for screening. The analyses proposed are poised to provide relevant, clinically useful results to inform the care of HIV+ patients. The results will also inform policy makers who are in the process of developing national guidelines for lung cancer screening, and will address early in the process of dissemination of lung cancer screening the role for screening in HIV.

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Publications

Short-term outcomes for lung cancer resection surgery in HIV infection.
Authors: Sigel K.M. , Stone K. , Wisnivesky J.P. , Park L.S. , Kong C.Y. , Silverberg M.J. , Brown S. , Goetz M. , Rodriguez-Barradas M.C. , Gibert C. , et al. .
Source: AIDS (London, England), 2019-07-01; 33(8), p. 1353-1360.
PMID: 30889013
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Association of Viral Suppression With Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study.
Authors: Park L.S. , Tate J.P. , Sigel K. , Brown S.T. , Crothers K. , Gibert C. , Goetz M.B. , Rimland D. , Rodriguez-Barradas M.C. , Bedimo R.J. , et al. .
Source: Annals of internal medicine, 2018-07-17; 169(2), p. 87-96.
EPub date: 2018-06-12.
PMID: 29893768
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Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ cell count at least 500 cells/μl.
Authors: Kong C.Y. , Sigel K. , Criss S.D. , Sheehan D.F. , Triplette M. , Silverberg M.J. , Henschke C.I. , Justice A. , Braithwaite R.S. , Wisnivesky J. , et al. .
Source: AIDS (London, England), 2018-06-19; 32(10), p. 1333-1342.
PMID: 29683843
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Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV-Positive and HIV-Negative Individuals in VACS (Veterans Aging Cohort Study).
Authors: Marconi V.C. , Duncan M.S. , So-Armah K. , Re V.L. , Lim J.K. , Butt A.A. , Goetz M.B. , Rodriguez-Barradas M.C. , Alcorn C.W. , Lennox J. , et al. .
Source: Journal of the American Heart Association, 2018-05-02; 7(10), .
EPub date: 2018-05-02.
PMID: 29720501
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Clinically significant mutations in HIV-infected patients with lung adenocarcinoma.
Authors: Thaler J. , Sigel C. , Beasley M.B. , Wisnivesky J. , Crothers K. , Bauml J. , Hysell K. , Emu B. , Borsu L. , Sigel K. .
Source: British journal of cancer, 2017-10-24; 117(9), p. 1392-1395.
EPub date: 2017-09-21.
PMID: 28934759
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An Assessment of Primary Care and Pulmonary Provider Perspectives on Lung Cancer Screening.
Authors: Triplette M. , Kross E.K. , Mann B.A. , Elmore J.G. , Slatore C.G. , Shahrir S. , Romine P.E. , Frederick P.D. , Crothers K. .
Source: Annals of the American Thoracic Society, 2018 01; 15(1), p. 69-75.
PMID: 28933940
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Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening.
Authors: Triplette M. , Sigel K.M. , Morris A. , Shahrir S. , Wisnivesky J.P. , Kong C.Y. , Diaz P.T. , Petraglia A. , Crothers K. .
Source: AIDS (London, England), 2017-07-31; 31(12), p. 1715-1720.
PMID: 28463881
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Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study.
Authors: Sigel K. , Wisnivesky J. , Crothers K. , Gordon K. , Brown S.T. , Rimland D. , Rodriguez-Barradas M.C. , Gibert C. , Goetz M.B. , Bedimo R. , et al. .
Source: The lancet. HIV, 2017 02; 4(2), p. e67-e73.
EPub date: 2016-12-02.
PMID: 27916584
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Baseline, Time-Updated, and Cumulative HIV Care Metrics for Predicting Acute Myocardial Infarction and All-Cause Mortality.
Authors: Salinas J.L. , Rentsch C. , Marconi V.C. , Tate J. , Budoff M. , Butt A.A. , Freiberg M.S. , Gibert C.L. , Goetz M.B. , Leaf D. , et al. .
Source: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016-12-01; 63(11), p. 1423-1430.
EPub date: 2016-08-18.
PMID: 27539575
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Fracture Prediction With Modified-FRAX in Older HIV-Infected and Uninfected Men.
Authors: Yin M.T. , Shiau S. , Rimland D. , Gibert C.L. , Bedimo R.J. , Rodriguez-Barradas M.C. , Harwood K. , Aschheim J. , Justice A.C. , Womack J.A. .
Source: Journal of acquired immune deficiency syndromes (1999), 2016-08-15; 72(5), p. 513-20.
PMID: 27003493
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Time trends in cancer incidence in persons living with HIV/AIDS in the antiretroviral therapy era: 1997-2012.
Authors: Park L.S. , Tate J.P. , Sigel K. , Rimland D. , Crothers K. , Gibert C. , Rodriguez-Barradas M.C. , Goetz M.B. , Bedimo R.J. , Brown S.T. , et al. .
Source: AIDS (London, England), 2016-07-17; 30(11), p. 1795-806.
PMID: 27064994
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Erratum to: Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011.
Authors: Rentsch C. , Tate J.P. , Akgün K.M. , Crystal S. , Wang K.H. , Ryan Greysen S. , Wang E.A. , Bryant K.J. , Fiellin D.A. , Justice A.C. , et al. .
Source: AIDS and behavior, 2016 Mar; 20(3), p. 565.
PMID: 25972072
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Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011.
Authors: Rentsch C. , Tate J.P. , Akgün K.M. , Crystal S. , Wang K.H. , Ryan Greysen S. , Wang E.A. , Bryant K.J. , Fiellin D.A. , Justice A.C. , et al. .
Source: AIDS and behavior, 2016 Mar; 20(3), p. 555-64.
PMID: 25711299
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Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: a meta-analysis.
Authors: Park L.S. , Hernández-Ramírez R.U. , Silverberg M.J. , Crothers K. , Dubrow R. .
Source: AIDS (London, England), 2016 Jan; 30(2), p. 273-91.
PMID: 26691548
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Virologic response and haematologic toxicity of boceprevir- and telaprevir-containing regimens in actual clinical settings.
Authors: Butt A.A. , Yan P. , Shaikh O.S. , Freiberg M.S. , Lo Re V. , Justice A.C. , Sherman K.E. , ERCHIVES (Electronically Retrieved Cohort of HCV Infected Veterans) Study Team .
Source: Journal of viral hepatitis, 2015 Sep; 22(9), p. 691-700.
EPub date: 2014-12-18.
PMID: 25524834
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Adherence and HIV RNA Suppression in the Current Era of Highly Active Antiretroviral Therapy.
Authors: Viswanathan S. , Justice A.C. , Alexander G.C. , Brown T.T. , Gandhi N.R. , McNicholl I.R. , Rimland D. , Rodriguez-Barradas M.C. , Jacobson L.P. .
Source: Journal of acquired immune deficiency syndromes (1999), 2015-08-01; 69(4), p. 493-8.
PMID: 25886923
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Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults.
Authors: Althoff K.N. , McGinnis K.A. , Wyatt C.M. , Freiberg M.S. , Gilbert C. , Oursler K.K. , Rimland D. , Rodriguez-Barradas M.C. , Dubrow R. , Park L.S. , et al. .
Source: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015-02-15; 60(4), p. 627-38.
EPub date: 2014-10-30.
PMID: 25362204
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Thoracic diseases associated with HIV infection in the era of antiretroviral therapy: clinical and imaging findings.
Authors: Chou S.H. , Prabhu S.J. , Crothers K. , Stern E.J. , Godwin J.D. , Pipavath S.N. .
Source: Radiographics : a review publication of the Radiological Society of North America, Inc, 2014 Jul-Aug; 34(4), p. 895-911.
PMID: 25019430
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Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer screening.
Authors: Sigel K. , Wisnivesky J. , Shahrir S. , Brown S.T. , Justice A. , Kim J. , Rodriguez-Barradas M.C. , Akgün K.M. , Rimland D. , Hoo G.W. , et al. .
Source: AIDS (London, England), 2014-04-24; 28(7), p. 1007-14.
PMID: 24401647
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Prognosis in HIV-infected patients with non-small cell lung cancer.
Authors: Sigel K. , Crothers K. , Dubrow R. , Krauskopf K. , Jao J. , Sigel C. , Moskowitz A. , Wisnivesky J. .
Source: British journal of cancer, 2013-10-01; 109(7), p. 1974-80.
EPub date: 2013-09-10.
PMID: 24022194
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