Lung Cancer in Patients With Immunodeficiency Syndrome

doi:10.1378/chest.103.2.410

Chest

Volume 103, Issue 2, February 1993, Pages 410-413

https://doi.org/10.1378/chest.103.2.410 Get rights and content

We report adenocarcinoma of the lung in seven patients with human immunodeficiency virus (HIV) infection. We compared age, clinical findings and survival data with a sex-matched control group of HIV-negative patients with adenocarcînoma of the lung. Median age of HIV-infected patients with lung cancer was lower than in control patients with lung cancer. The HIV-infected patients had more systemic symptoms and abnormal physical findings than control subjects. Both groups had smoking histories. Laboratory data were similar but control subjects had lower blood oxygen tensions than did HIV patients; HIV patients had more abnormalities on chest roentgenograms and computed tomography scans than did control subjects. All HIV-infected patients were stage IV. Median survival was 4 weeks. For control patients, 50 percent had stage IV disease; median survival was 25.5 weeks. Thus, patients with HIV infection develop lung cancer at a younger age than sex-matched control subjects and undergo a more fulminant course with shortened survivals.

Section snippets

METHODS

A retrospective chart review was conducted at the Montefiore Medical Center, New York, spanning the period of January 1,1983, to September 1, 1991. Patients were identified using ICD-9 codes for lung cancer (162.9), AIDS (042.9), HIV (044.9), and AIDS-related complex (ARC) (043.9). Two hundred and five charts were reviewed. Demographic and clinical data were recorded for each individual patient with adenocarcinoma of the lung and AIDS or HIV infection or both. Charts were reviewed with

RESULTS

Seven patients (six male, one female) with adenocarcinoma of the lung and AIDS or HIV infection were identified during the time period specified. Fourteen control subjects were identified who were diagnosed with lung cancer and were not known to have HIV infection (Table 1). Patients were significantly younger than control subjects (median, 38 vs 60.5 years; p=0.0006). All smoked cigarettes, but AIDS-HIV patients had significantly lower pack-year exposure than control subjects. One AIDS-HIV

DISCUSSION

This article reports a series of patients with AIDS or HIV infection and an unusual occurrence of adenocarcinoma of the lung. A case-control comparison of such patients with other adenocarcinoma patients without signs of HIV infection demonstrates that the HIV-positive patients are significantly younger at presentation, present with more advanced disease and have a shorter life expectancy after diagnosis than those with known HIV

Although patients with AIDS are most commonly treated for

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Chest CT Findings in Patients with HIV Presenting to the Emergency Department: A Single Institute Experience
2023, Current Problems in Diagnostic Radiology
The aim of this study was to analyze chest CT imaging findings and relevant clinical factors in patients with HIV presenting to the emergency department (ED).
A retrospective review was performed to identify patients with HIV who received chest CT imaging evaluation in the acute ED setting. Analyzed patients included adults with a known diagnosis of HIV who presented to the ED at a single tertiary care center between 2004 and 2020 and received chest CT imaging. Chest CT findings were assessed by 2 radiologist readers, and relevant clinical data were gathered. Statistical analysis was performed to determine if imaging and clinical factors demonstrate significant associations with CD4 count, viral load, and antiretroviral therapy status.
A total of 113 patients with HIV were identified who presented to the ED and underwent chest CT imaging evaluation (mean age 47 ± 11 years). Frequently detected chest CT findings included infectious pneumonia (24%), malignancy (11%), pleural effusion (17%), pericardial effusion (13%), and pulmonary embolism (4%). CD4 count, viral load, and active retroviral therapy demonstrated statistically significant associations with a number of key imaging and clinical factors, including presence of pneumonia, malignancy, average length of hospital admission, and survival.
Patients with HIV present with a wide range of imaging findings when presenting in the acute ED setting. CD4 count, viral load, and active retroviral therapy status demonstrate statistically significant associations with multiple key imaging findings and clinical factors. Chest CT plays an integral role in the clinical management of this unique patient population.
Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines
2013, Chest
Ever since a lung cancer epidemic emerged in the mid-1900s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research.
A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk.
Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application.
Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers.
Epidemic of lung cancer in patients with hiv infection
2013, Chest
The survival of patients with HIV infection has improved dramatically over the past 20 years, largely owing to a significant reduction in opportunistic infections and AIDs-defining malignancies, such as lymphoma and Kaposi sarcoma. However, with improved survival, patients with HIV are experiencing morbidity and mortality from other (non-AIDs-defining) complications, such as solid organ malignancies. Of these, the leading cause of mortality in the HIV-infected population is lung cancer, accounting for nearly 30% of all cancer deaths and 10% of all non-HIV-related deaths. Importantly, the average age of onset of lung cancer in the HIV-infected population is 25 to 30 years earlier than that in the general population and at lower exposure to cigarette smoke. This article provides an overview of the epidemiology of lung cancer in the HIV-infected population and discusses some of the important risk factors and pathways that may enhance the risk of lung cancer in this population.
Lung cancer in HIV infection
2012, Clinical Lung Cancer
Citation Excerpt :
Enlarged lymph nodes were present in 60% and distant metastases in 30% of patients. Another study showed a higher frequency of mediastinal adenopathy (6/7 versus 7/14) and pleural effusion (4/7 versus 4/14) in HIV-infected patients compared to a sex-matched control group of HIV-negative patients with adenocarcinoma of the lung, although these differences did not reach statistical significance.64 Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population.
Lung cancer is the most prevalent non–AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.
Lung cancer in HIV-positive patients
2010, Journal of Thoracic Oncology
Citation Excerpt :
Lung cancer represents 5% of all deaths and 15% of all cancer deaths in the HIV population.14 Traditionally, patients with lung cancer and HIV disease experience a shorter median survival of only 3 to 9 months and have a poor overall prognosis.8,25,26,41,43,46,85 In a study by Sridhar et al.,42 the median survival was 3 months for HIV-infected patients with lung cancer, compared with 10 months in a matched non-HIV control group.
Malignancies account for more than a third of all deaths in human immunodeficiency virus (HIV)-positive patients. Although acquired immunodeficiency syndrome-related mortality is decreasing with the introduction of effective antiretroviral therapy, the incidence of lung cancer in patients with HIV remains high. Lung cancer has now become the leading cause of mortality among the nonacquired immunodeficiency syndrome defining malignancies. Within the HIV population, the incidence of lung cancer is estimated to be approximately 2 to 4 times that of the general population. Often these patients present with advanced disease (stage III or IV) at a younger age and have an inferior overall survival, when compared with non-HIV patients. Development of lung cancer in patients with HIV has been linked to various factors including immunosuppression, CD4 count, viral load, and smoking. This article reviews the impact of HIV on the incidence, risk factors, clinical presentation, and treatment of lung cancer.
Effect of highly active antiretroviral therapy on survival of HIV infected patients with non-small-cell lung cancer
2009, Lung Cancer
Citation Excerpt :
A high prevalence of smoking may contribute to the increased LC risk in this population; nonetheless, it is uncertain whether other co-factors are involved in the etiology of LC among HIV infected individuals [9–11]. The average age of HIV infected patients is younger [12–16] and the prognosis is worse than in the general population [12–17], but very few studies have focused on prognostic factors for survival among HIV patients with non-small-cell-lung carcinoma (NSCLC). All patients recorded as having both HIV infection and NSCLC from June 1996 to March 2007 in the database of the two University hospital (Tenon Hospital and Saint Antoine Hospital, Paris EST, France) were enrolled in the study.
To evaluate the impact of highly active antiretroviral therapy (HAART) on survival in HIV infected patients with non-small-cell lung cancer (NSCLC).
All consecutive HIV infected patients with NSCLC diagnosed between 06/1996 and 03/2007 at two University hospitals in Paris (France) were prospectively followed until death. The association between survival and clinical and biological factors was analyzed by univariate and multivariate models. Survival analysis was performed by Kaplan–Meier estimates and the Cox proportional hazards regression model.
During the study period, NSCLC was diagnosed in 49 consecutive HIV infected patients (median age 46 years); 84% had advanced disease. Median survival was 8.1 months (range 5–10 months). In multivariate analysis, baseline parameters with significant positive impact on survival included performance status (PS) ≤1 (HR = 0.2, 95%CI [0.09, 0.46], p = 0.0001), stage I–II disease (HR = 0.15, 95%CI [0.04, 0.53], p = 0.003), and use of HAART (HR = 0.4, 95%CI [0.2, 0.9], p = 0.027).
HAART is a good prognostic factor for survival in HIV infected patients with NSCLC. Stage of disease and PS are two other valid survival prognostic factors.

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Presented in part at the 57th Annual Scientific Assembly, American College of Chest Physicians, San Francisco, November 4-8, 1991.

Manuscript received April 6; revision accepted June 16.

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Chest

Lung Cancer in Patients With Immunodeficiency Syndrome

Section snippets

METHODS

RESULTS

DISCUSSION

Am J Med

Am J Med

Clin Immunol Immunopathol

Prevalence of Kaposi's sarcoma among patients with AIDS

N Engl J Med

Pulmonary neoplastic and lymphoproliferative disease in AIDS: a review

Radiology

Non-Hodgkin's lymphomas and other malignancies in the acquired immune deficiency syndrome

Semin Oncol

NIH Conference: acquired immunodeficiency syndrome-epidemiologic, clinical, immunologic and therapeutic considerations

Ann Intern Med