Outcomes of lung cancer screening in a nation-wide matched cohort of people with HIV compared to people without HIV

Background: People with HIV are at higher risk for lung cancer than the general population; however, it remains uncertain whether they have similar outcomes from lung cancer screening. Objective: To compare lung cancer screening findings and outcomes in a nationwide matched cohort of people with and without HIV.

Methods: This was a retrospective analysis of the Veterans Aging Cohort Study, which includes all people with HIV in the Veterans Health Administration with two comparators without HIV matched by age, sex, race/ethnicity, and site of care. We included participants age 50-82 with current or former smoking and a low-dose CT from 01/2019-06/2023 with identifiable Lung CT Screening Reporting and Data System (Lung-RADS) categorizations. Our primary outcome was a positive Lung-RADS finding; secondary outcomes were rates of follow-up invasive procedures and lung cancer.

Results: 2,899 people with HIV and 5,580 comparators without HIV underwent low-dose CT with medians ages of 64 years (interquartile range 59-68) and 64 years (interquartile range 60-69), respectively, and with 3.2% and 2.9% female sex, respectively. People with HIV were less likely to currently smoke (65.5% vs. 69.0%, p=0.001) or have COPD (23.9% vs. 28.9%, p<0.001), and more likely to have had pneumonia (4.0% vs. 2.5%, p<0.001). People with HIV were more likely to have a positive Lung-RADS finding (odds ratio 1.18, 95% confidence interval 1.04–1.33, p=0.009), especially those with detectable HIV viral load or low CD4 cell count. Rates of invasive procedures and lung cancer did not differ.

Conclusions: In a matched cohort of veterans, people with HIV were more likely to have positive Lung-RADS findings but had similar outcomes to people without HIV. The small but increased rate of positive Lung-RADS, without increased lung cancer, may suggest a higher incidence of false-positive findings in people with HIV.