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Lung cancer in patients living with HIV infection

Meijide, Hectora; Mena, Alvaroa; Marcos, Pedro J.b; Rodriguez-Osorio, Iriaa; Suárez-Fuentetaja, Rebecaa; Castro, Angelesa; Poveda, Evaa; Pedreira, Jose D.a

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doi: 10.1097/QAD.0000000000000840
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We read with interest the article by Hessol et al.[1] regarding the characteristics of lung cancers in a large HIV population cohort. Incidence rates of several common malignancies, including lung cancer, are rising in HIV-infected patients. Although cigarette smoking is probably the main known risk factor [2,3], ageing, existing pulmonary disease, HIV-related immunosuppression and inflammation due to HIV could lead to immune system dysfunction and promote the development of lung cancer in this population as described recently [4].

We would like to share our experience regarding this issue. We conducted an observational retrospective study in a single centre in the Northwest of Spain. Between 1993 and 2013, we detected 28 lung cancers, with a 24 330 person-years follow-up. Similar to the data reported by Hessol et al.[1], we observed a trend to a higher diagnosis of lung cancer in the last decade than the first (1993–2003: eight cases vs. 2003–2013: 20 cases) The profile patient is a young man (mean age 49 ± 9 years old), heavy smoker (more than 85% of our cohort were active smokers), with an intravenous drug use background, Centers for Disease Control and Prevention-C AIDS category, mainly with undetectable viral load and a reasonable immunological status. The mean time from the HIV infection to the diagnosis of lung cancer was 9.8 ± 6.6 years. As reported by Hessol et al.[1], we found that adenocarcinoma was the most common histological type (50% of the cases). This differs from studies of non-HIV Spanish population, wherein squamous cell carcinoma is the most prevalent in men [5]. Similar to non-HIV observed data, most of the lung cancer was diagnosed in advanced stages, as 22 patients (78%) were in stages III or IV, with a mean survival time of 9.6 ± 4.3 months [95% confidence interval (95% CI) 1.1–18.2]; the Kaplan–Meier analysis is shown in Fig. 1. Our results are quite similar to those described by Okuma et al.[6], who conducted a study in Japanese population, with important environmental and ethnic differences, suggesting that, therefore, genetic and the role of HIV infection may be contributing to lung cancer development.

Fig. 1
Fig. 1:
Kaplan–Meier survival analysis (mean survival ± SD in months) comparing lung cancer stages at the moment of diagnosis.

In summary, as the survival of HIV-infected patients is improving, it is expected that the incidence and mortality from lung cancer will increase. From a preventive point of view, smoking cessation seems mandatory and, although controversial [7,8], further research regarding the impact of low-dose computed tomography screening in this high-risk population will be welcomed [7,8].


Conflicts of interest

There are no conflicts of interest.


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