The biological mechanisms underlying the association between HIV infection and increased risk of mortality among lung cancer patients are unclear at present. HIV infection is associated with poor immune regulatory function, which may make the immune system in lung cancer patients lose the ability to control the proliferation or metastasis of tumor cells.[57,58] It has also been suggested that the respiratory system is particularly susceptible to the damages caused by HIV-related immunosuppression. Some infectious and noninfectious pulmonary diseases are also associated with lung cancer patients, and since HIV-related immunosuppression can result in infectious and noninfectious pulmonary diseases, and HIV infection can thus promote the progression of lung cancer. However, the molecular mechanisms explaining the increased risk of mortality among lung cancer patients with HIV infection are still poorly defined, and more future studies are recommended to provide new insights into it.
There were several strengths in the study. First, the total number of included participants was large and could lead to a correct estimate of the role of HIV infection in lung cancer patients. Second, the consistent outcomes in the sensitivity analyses proved the credibility of the pooled outcomes. Finally, all included studies provided adjusted RRs which had controlled the impact of other confounding factors on the association between HIV infection and prognosis of lung cancer patients. The pooled outcomes based on adjusted risk estimates showed that HIV infection was an independent risk factor of mortality in lung cancer patients.
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