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

Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening.
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Triplette M, Sigel KM, Morris A, Shahrir S, Wisnivesky JP, Kong CY, Diaz PT, Petraglia A, Crothers K,


Triplette M, Sigel KM, Morris A, Shahrir S, Wisnivesky JP, Kong CY, Diaz PT, Petraglia A, Crothers K, (click to view)

Triplette M, Sigel KM, Morris A, Shahrir S, Wisnivesky JP, Kong CY, Diaz PT, Petraglia A, Crothers K,

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AIDS (London, England) 31(12) 1715-1720 doi 10.1097/QAD.0000000000001529

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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