Jointly conducted by IRD and INSERM, this research explores the screening of broncho-pulmonary cancer in people living with HIV.
Alain Makinson, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2015 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Alain Makinson's thesis highlights a major public health issue: broncho-pulmonary cancer (BPC) in people living with HIV (PLHIV). Indeed, this population is often overlooked in cancer screening and treatment strategies, despite increased risks related to factors such as smoking and antiretroviral treatments. Broncho-pulmonary cancer poses a serious threat to the health of PLHIV, as these individuals are often exposed to carcinogenic agents, whether through their lifestyle or the side effects of their treatments. Research has shown that screening by chest computed tomography (CT) without contrast injection is not only feasible but also beneficial for identifying cancers at an early stage, thereby increasing the chances of recovery.
The results of the ANRS EP48 HIV CHEST study, which included 442 at-risk PLHIV, reveal that early screening can allow for the diagnosis of localized cancers, often treatable. Indeed, early diagnosis enables rapid intervention, which is crucial in the treatment of BPC. Furthermore, the absence of serious complications during diagnostic explorations reassures regarding the safety of this approach. This point is particularly important in the context of PLHIV, where the fear of complications may deter patients from undergoing necessary examinations. The study also proposes a screening age limit of 45 years for PLHIV, which could transform current screening practices in this population. This raises questions about the need to adapt screening protocols according to the specificities of this vulnerable population.
It is essential to note that the management of PLHIV with BPC should be similar to that of the general population. However, complications may arise due to interactions between antiretrovirals and cytotoxic drugs. This underscores the importance of close coordination between oncology and infectious disease teams, as well as a good understanding of the pharmacokinetics of treatments. For example, some antiretrovirals may influence the metabolism of drugs used in cancer treatment, necessitating careful monitoring and dose adjustments.
Comorbidities such as COPD (chronic obstructive pulmonary disease) and emphysema are also prevalent among PLHIV, requiring a holistic approach to their management. The coexistence of these respiratory diseases with BPC complicates the clinical picture and requires special attention. Research emphasizes the need to reduce risk behaviors, particularly smoking, to improve the overall health of this population. Awareness and smoking cessation programs specifically targeted at PLHIV could have a significant impact on reducing cases of BPC.
In summary, this thesis paves the way for new screening and treatment strategies that could have a significant impact on the lives of PLHIV. By integrating innovative screening methods such as non-contrast CT, we can hope for improved survival rates and a better quality of life for these patients. It is crucial that policymakers and healthcare professionals take these results into account to develop appropriate public health policies.
The rigor of this research is reinforced by its dual validation, both by international co-supervision and ABES/STAR certification, ensuring a high level of academic rigor. This validation is essential to ensure that the study's results are taken seriously and can influence clinical practices. In conclusion, Alain Makinson's thesis represents a significant advancement in the understanding and management of broncho-pulmonary cancer in people living with HIV, and it calls for concerted action to improve the screening and treatment of this disease in this vulnerable population.
Key Facts
- 442 : number of people living with HIV included in the ANRS EP48 HIV CHEST study, demonstrating the feasibility of CBP screening.
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Sources and Access
Alain Makinson. Prévention, diagnostic précoce et traitement du cancer broncho-pulmonaire chez les personnes vivant avec le VIH : apport de la tomodensitométrie thoracique sans injection de produit de contraste. Médecine humaine et pathologie. Université Montpellier, 2015. Français. ⟨NNT : 2015MONTT021⟩. ⟨tel-01342175⟩