HIV Infections, HIV Seropositivity, Lung Cancer, Lung Cancer in the HIV Patient
Conditions
Brief summary
That computed tomography (CT) screening of HIV-seropositive heavy smokers will detect early stage lung cancer at significantly higher rates than what is currently being observed.
Detailed description
The study design is that of a prospective cohort study in which 200 smoking participants will be recruited from an existing HIV-seropositive cohort of 800 patients (the Human Oral Papillomavirus Etiology (HOPE) Study). Participants will be enrolled from the Johns Hopkins HIV (Moore) Clinic and the resources of the Johns Hopkins Adult Outpatient General Clinical Research Center (GCRC) and pilot project funding from the Lung Cancer SPORE will be utilized to fund the costs of the CT scans. An interdisciplinary team with expertise in HIV-associated malignancy, CT screening, lung cancer surgery, HIV infection, epidemiology and biostatistics has been assembled to test the hypothesis by accomplishing the following Specific Aims:
Interventions
DEVICECT Scan with Spirometry
During the screening and later during the five annual study visits the patients will be scheduled to undergo total of five CT scans. The first CT scan will take place at the beginning of the study and then each year for a period of five years.
Sponsors
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
26 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Age over 25 years old. * Confirmed HIV seropositive by ELISA assay * No woman who has a positive serum pregnancy * Current or previous cumulative cigarette smoking history of \> 20 pack years * Former smokers must have quit smoking within the previous 15 years. * No medical or psychiatric condition precluding informed medical consent. * Ability to lie on the back with arms raised over the head. * No metallic implants or metallic devices in the chest or back (pacemakers or Harrington rods, etc.) that would cause sufficient beam hardening artifact. * No prior history of lung cancer. * No prior removal of any portion of the lung, excluding percutaneous lung biopsy. * No requirement for home oxygen supplementation for respiratory conditions. * No participation in cancer prevention trials except smoking cessation programs * No pneumonia or acute respiratory infection within 12 weeks of enrollment that was treated with antibiotics under physician supervision. * No individuals within 6 months of receipt of cytotoxic agents for any condition. * No chest CT scan within the preceding 6 months * Signed study-specific informed consent prior to study entry.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stage distribution of HIV-seropositive patients | Day 1 | To determine differences in stage distribution of HIV-seropositive patients at lung cancer diagnosis between those who are screened by spiral CT and historic controls. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To create a specimen bank of serum, sputum, and tissue | 5 years | To create a specimen bank of serum, sputum, and tissue from the cohort of heavy smokers with HIV at high risk for lung cancer identified in Specific Aim 1. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Epigenetic analysis of sera and sputa | 4 weeks | To use epigenetic analysis of sera and sputa collected in Specific Aim 2 from patients screened in Specific Aim 1 as a complementary approach to low dose helical CT in order to discriminate radiologically indeterminate nodules as either molecularly positive or negative. |
Outcome results
None listed