Lung cancer in HIV-infected patients

Abstract

PurposeSeveral studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients. MethodsThe clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992Á2012) were reviewed, and all patients with a lung cancer were analysed. ResultsThere were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%), and smokers (96.6%; mean pack-years 35.2), with a median age of 48.0 (41.7Á52.9) years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7%) patients were Aids cases, and 29 (47.5%) had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm 3 (42Á232), the median CD4 count at the time of diagnosis of the lung cancer was 237/mm 3 (85Á397), and 66.1%B350/mm 3 . 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0%) and 23 (38.3%) cases, respectively. There were 49 (80.3%) cases with advanced stages (III and IV) at diagnosis. The distribution of treatments was: only palliative 23 (39.7%), chemotherapy 14 (24.1%), surgery and chemotherapy 8 (13.8%), radiotherapy 7 (12.1%), surgery 4 (6.9%), and other combined treatments 2 (3.4%). Forty-six (76.7%) patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%). ConclusionsThe prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis. Adenocarcinoma is the most frequent histological type. The diagnosis is usually made at advanced stages of the neoplasm, and mortality is high.

Lung cancer incidence and survival among HIV-infected and uninfected women and men

“…We found that approximately two-thirds of the effect of HIV infection was explained by a diagnosis of prior AIDS-pneumonia. Our results are consistent with other studies that have reported an increased risk of lung cancer among HIV-infected adults with prior lung disease and/or AIDS pneumonia [15, 28, 29]. …”

“…Pre-existing lung disease, both infectious and non-infectious diseases, including asthma, has been associated with a trend toward increased lung cancer risk [15, 28]. Consistent with these trends, a study investigating the role of AIDS-defining pulmonary infections on the subsequent risk of lung cancer reported that HIV-infected individuals with recurrent pneumonia were at significantly higher lung cancer risk than those without this history, after adjusting for age, race, sex, HIV acquisition mode, CD4 lymphocyte count, and AIDS diagnosis year [29].…”

Immunodeficiency, AIDS-related pneumonia, and risk of lung cancer among HIV-infected individuals

“…The remaining increased risk may be explained by HIV-associated factors, such as immunodeficiency or a higher incidence of pulmonary infections that increase lung cancer risk, possibly as a result of inflammation [14-16]. However, studies of the impact of immunodeficiency on lung cancer have had mixed results [10, 17-19], and those that have examined the role of pneumonia have had few lung cancer cases [10, 20] or lacked an internal HIV-uninfected comparison group [15, 21]. …”

HIV and smoking: associated risks and prevention strategies

“…A review of the epidemiologic data indicates that, controlling for cigarette smoking, the prevalence of lung cancer is two to four times greater in the HIV+ population than in the general population. 35 Lung cancer is the most frequent non-AIDs associated tumor in HIV+ patients, and overall the third most common malignancy, preceded only by Kaposi’s sarcoma and non-Hodgkin lymphoma. 35 Perceptibly, lung cancer prevalence rates are only further compounded by the predominance of cigarette dependence within the HIV+ population and the success of antiretroviral therapy in prolonging life expectancies.…”