We read with interest the article by Hessol et al. 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 .
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., 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., 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 . 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., 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.
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.
1. Hessol NA, Martinez-Maz O, Levine AM, Morris A, Margolick JB, Cohen MH, et al. Lung cancer incidence and survival among HIV-infected and uninfected women and men
2. Winstone TA, Man FP, Hull M, Montaner JS, Sin DD. Epidemic of lung cancer in patients with HIV infection
3. Sigel K, Wisnivesky J, Gordon K, Redfield RR, Dennis PA, Bryant J. HIV as an independent risk factor for incident lung cancer
4. Kawabata S, Heredia A, Gills J, Redfield RR, Dennis PA, Bryant J. Impact of HIV on lung tumorigenesis in an animal model
5. Sanchez de Cos J, Serra M, Hernandez J, Hernandez H. The Spanish Society of Pulmonology and Thoracic Surgery Lung Cancer Cooperative Group-II Registry. A Descriptive Study
. Arch Bronconeumol
6. Okuma Y, Tanuma J, Kamiryo H, Kojima Y, Youtsumoto M, Ajisawa A, et al. A multiinstitutional study of clinicopathological features and molecular epidemiology of epidermal growth factor receptor mutations in lung cancer patients living human immunodeficiency virus infection
. J Canc Res Clin Oncol
2015; (Epub ahead of print).
7. Sigel K, Wisnivesky J, Shahrir S, Brown ST, Justice A, Kim J, et al. Findings in asymptomatic HIV-infected patients undergoing chest computed tomography testing: implications for lung cancer
8. Black WC, Gareen IF, Soneji SS, Sicks JD, Keeler EB, Aberle DR, et al. Cost-effectiveness of CT screening in the National Lung Screening Trial
. N Engl J Med