Lung Cancer in HIV Infection

Abstract

Lung cancer is the most prevalent non-AIDS-defining malignancy in the HAART era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is 2-4 times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the commonest histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Since pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies for this population frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.

Lung cancer in HIV-infected patients

“…23,24 In almost all the series of LC in HIV-infected patients, the most usual histological type is adenocarcinoma. 11,15,16 In our series, the most common histological types were adenocarcinoma and squamous cell carcinoma, which accounted for almost the same number of cases, unlike in the general population where adenocarcinoma only accounts for 13% of cases. LC in both HIV-infected and uninfected populations presents at advanced stages, with a very high mortality in the HIV-infected population and no differences according to whether the viral load is or is not detectable.…”

“…[4][5][6][7][8][9][10][11][12] The risk of LC among HIV-infected individuals is more pronounced in most previous studies, with adjusted incidence rate ratios ranging from 2.2 to 4.7 when comparing HIV-infected with uninfected persons. 5,[7][8][9][10][11][14][15][16][17] However, a recent study that compared HIV-infected and uninfected individuals enrolled in Kaiser Permanente observed demographically-adjusted incidence rate ratios of 1.8 and 1.2 in an adjusted analysis, including smoking. 18 Although LC remains more common in men, in our series there was a notable presence of women.…”

“…11,21 On the other hand, smoking, associated with the LC, was less common in the HIV-infected patients than the non-infected patients. This suggests that other factors apart from sex, age and smoking may influence the development of LC in this particular population.…”

Cancers in People with HIV and AIDS

“…Though limited experimental data suggest that HIV tat (Trans-Activator of Transcription) gene product may modulate the expression of proto-oncogenes and tumor suppressor genes, amplifi cation of HIV sequences in lung carcinoma has not been demonstrated (el-Solh et al 1997 ;Wistuba et al 1998 ). Other potential mechanisms for the role of HIV in the pathogenesis of lung cancer include accelerated lung damage through recurrent pulmonary infections and increased susceptibility to tobacco carcinogens through genomic instability (Kirk and Merlo 2011 ;Mani et al 2012 ).…”

“…Lung cancer typically is diagnosed a decade or more earlier among HIV-infected persons compared to those without HIV infection ( Mani et al 2012 ). However, after adjustment for difference in the age compositions of populations at risk, the difference in the age at diagnosis of lung cancer (50 vs. 54 years) is relatively modest between persons with AIDS and the general population .…”