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Delayed Diagnosis and Elevated Mortality in an Urban Population With HIV and Lung Cancer: Implications for Patient Care

Brock, Malcolm V. MD*; Hooker, Craig M. MPH*; Engels, Eric A. MD, MPH*†; Moore, Richard D. MD*‡; Gillison, Maura L. MD, PhD*‡; Alberg, Anthony J. PhD; Keruly, Jeanne C. RN*; Yang, Stephen C. MD*; Heitmiller, Richard F. MD; Baylin, Stephen B. MD*; Herman, James G. MD*; Brahmer, Julie R. MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 2006 - Volume 43 - Issue 1 - p 47-55
doi: 10.1097/01.qai.0000232260.95288.93
Clinical Science

Objective: Lung cancer is more common in HIV-infected patients than in the general population. We examined how effectively lung cancer was being diagnosed in our HIV-infected patients.

Methods: Retrospective study assessing clinical diagnosis of lung cancer in HIV-infected patients at Johns Hopkins Hospital between 1986 and 2004.

Results: Ninety-two patients were identified. Compared to HIV-indeterminate patients (n = 4973), HIV-infected individuals were younger with more advanced cancer. CD4 counts and HIV-1 RNA levels indicated preserved immune function. Mortality was higher in HIV-infected patients, with 92% dying of lung cancer (hazard ratio, 1.57; 95% confidence interval, 1.25-1.96), compared to HIV-uninfected patients. Advanced stage and black race were associated with worse survival. After adjustment for these factors, HIV infection was not associated with increased mortality (hazard ratio, 1.04; 95% confidence interval, 0.83-1.32). Of 32 patients followed in our HIV clinic, 60% of chest radiographs had no evidence of neoplasm within 1 year of diagnosis compared to only 1 (4%) of 28 chest computed tomography scans. Nonspecific infiltrates were observed in 9 patients in the same area that cancer was subsequently diagnosed.

Conclusions: HIV-infected lung cancer patients have shortened survival mainly due to advanced stage. Low clinical suspicion and overreliance on chest radiographs hindered earlier detection. Aggressive follow-up of nonspecific pulmonary infiltrates in these patients is warranted.

From the *Johns Hopkins Hospital, Baltimore, MD; †Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; ‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and §Union Memorial Hospital, Baltimore, MD.

Received for publication February 11, 2006; accepted May 30, 2006.

M.V.B., S.B.B., J.G.H., and J.R.B. are supported in part by the National Cancer Institute grant CA058184-10; A.J.A. is supported in part by the NIH grant 5U01CA086308; M.V.B. and R.D.M. are supported in part by the NIH Center for AIDS Research P30-A142855, NCI grant CA117820-01; and E.A.E. is supported by the Intramural Program of the National Cancer Institute.

The authors state that they have no proprietary interest in the products named in this article.

Reprints: Malcolm V. Brock, MD, Johns Hopkins Medical Institutions, 600 North Wolfe, Blalock 240, Baltimore, MD 21287 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.