This study will evaluate the cost-effectiveness of lung cancer screening in HIV infected (HIV+) persons. Candidate: The primary objective of this application is to support Dr. Keith Sigel's career development into an independent investigator in the field of HIV-associated malignancies. Dr. Sigel's career goal is to improve cancer prevention in HIV+ persons by evaluating the unique harms, benefits and costs associated with cancer screening in this population. His proposed training plan focuses on 3 areas: (1) Cohort Study Design; (2) Decision Analysis; and (3) Cost-effectiveness Analysis. Environment: Mount Sinai is a national leader in research and is one of the top 20 medical schools in NIH funding. It is the largest academic provider of HIV care in New York and has one of the largest lung cancer screening research programs in the world. Research: Cancers are emerging as the leading cause of death in HIV+ persons, and lung cancer accounts for the majority of these deaths. Furthermore, HIV+ persons have more than twice the risk of lung cancer of HIV- persons. Lung cancer screening with low dose computed tomography (LDCT) has demonstrated a considerable mortality benefit among HIV- heavy smokers. An increased risk of lung cancer and a high rate of smoking (>70%) suggests that the HIV+ population is an important high-risk group to target for lung cancer screening. However, frequent prior lung infections in HIV+ persons may cause more false positive screening tests (which may lead to invasive procedures with significant complications). Thus, the harms, benefits and costs associated with lung cancer screening in HIV- persons may be different in HIV+ persons. Therefore, our aims are to: (1) determine the rate of positive screening LDCTs and subsequent clinical evaluations in HIV+ smokers and compare to a similar cohort of previously screened HIV- smokers; (2) estimate harms and benefits of annual LDCT lung cancer screening in HIV+ smokers using a simulation model; and (3) determine the lifetime costs and evaluate the cost-effectiveness of annual LDCT cancer screening vs. usual care in HIV+ smokers. We will conduct a prospective study assessing LDCT screening findings in a cohort of HIV+ smokers, comparing findings to matched HIV- controls from an existing screening study. Using these and other data, we will create a simulation model of lung cancer screening in HIV+ patients. We will then measure costs associated with screening in HIV+ persons to incorporate into our model, providing cost-effectiveness estimates of LDCT screening in HIV+ individuals.

Public Health Relevance

Lung cancer is a major cause of death in the HIV infected population, and lung cancer screening with low dose computed tomography (CT) has been shown to dramatically decrease lung cancer deaths in smokers without HIV infection. High rates of prior lung infections may alter the harms and benefits of lung cancer screening in HIV infected persons. Therefore, in this study we will determine whether lung cancer screening with low dose CT scanning is a safe, efficacious and cost-effective test in persons with HIV infection.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Academic/Teacher Award (ATA) (K07)
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Study Section
Subcommittee I - Transistion to Independence (NCI)
Program Officer
Perkins, Susan N
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Liu, Yuxin; Blakely, Morgan; Sigel, Keith et al. (2018) Biomarker P16 predicts progression risk of anal low-grade squamous intraepithelial lesions. AIDS 32:2309-2316
Kale, Minal S; Sigel, Keith; Mhango, Grace et al. (2018) Assessing the extent of non-aggressive cancer in clinically detected stage I non-small cell lung cancer. Thorax 73:459-463
Liu, Yuxin; Gaisa, Michael M; Wang, Xiaofei et al. (2018) Differences in the Immune Microenvironment of Anal Cancer Precursors by HIV Status and Association With Ablation Outcomes. J Infect Dis 217:703-709
Sigel, Carlie S; Krauss Silva, Vitor Werneck; Reid, Michelle D et al. (2018) Well differentiated grade 3 pancreatic neuroendocrine tumors compared with related neoplasms: A morphologic study. Cancer Cytopathol 126:326-335
Buckstein, Michael; Arens, Yotam; Wisnivesky, Juan et al. (2018) A Population-Based Cohort Analysis of Chemoradiation Versus Radiation Alone for Definitive Treatment of Stage I Anal Cancer in Older Patients. Dis Colon Rectum 61:787-794
Liu, Yuxin; Alqatari, Mahfood; Sultan, Kieran et al. (2017) Using p16 immunohistochemistry to classify morphologic cervical intraepithelial neoplasia 2: correlation of ambiguous staining patterns with HPV subtypes and clinical outcome. Hum Pathol 66:144-151
Sigel, Keith; Wisnivesky, Juan; Crothers, Kristina et al. (2017) Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study. Lancet HIV 4:e67-e73
Liu, Yuxin; Wang, Xiaofei; Kalir, Tamara et al. (2017) Anal High-Grade Squamous Intraepithelial Lesions in Human Immunodeficiency Virus-Infected Men: A Study of 100 Cases With Emphasis on Cytohistologic Correlation. Am J Clin Pathol 147:315-321
Sigel, Keith; Makinson, Alain; Thaler, Jonathan (2017) Lung cancer in persons with HIV. Curr Opin HIV AIDS 12:31-38
Triplette, Matthew; Sigel, Keith M; Morris, Alison et al. (2017) Emphysema and soluble CD14 are associated with pulmonary nodules in HIV-infected patients: implications for lung cancer screening. AIDS 31:1715-1720

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