Secondary Logo

Journal Logo

Correspondence

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

Author Information
doi: 10.1097/QAD.0000000000000840
  • Free

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].

Acknowledgements

Conflicts of interest

There are no conflicts of interest.

References

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. AIDS 2015; 29:1183–1193.
2. Winstone TA, Man FP, Hull M, Montaner JS, Sin DD. Epidemic of lung cancer in patients with HIV infection. Chest 2013; 143:305–314.
3. Sigel K, Wisnivesky J, Gordon K, Redfield RR, Dennis PA, Bryant J. HIV as an independent risk factor for incident lung cancer. AIDS 2012; 26:1010–1025.
4. Kawabata S, Heredia A, Gills J, Redfield RR, Dennis PA, Bryant J. Impact of HIV on lung tumorigenesis in an animal model. AIDS 2015; 29:633–635.
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 2013; 49:462–467.
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. AIDS 2014; 28:1007–1014.
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 2014; 371:1793–1802.
Copyright © 2015 Wolters Kluwer Health, Inc.