HIV and Lung Cancer

Abstract

Lung cancer patients with HIV infection are expected to become an emerging issue with respect to morbidity and mortality, as the number of such patients is rapidly increasing. However, few reports or textbooks dealing with this issue have documented the details of these cases. Thus, in clinical settings, infectious disease physicians or medical oncologists occasionally hesitate to treat HIV-infected patients with lung cancer. Since 1996, the outcome of HIV-infected patients has improved, because CD4 cell counts and viral load are generally well controlled with the advent of highly active antiretroviral therapy (HAART), which strongly inhibits HIV viral proliferation and restores the patient’s immunological status. Furthermore, the prognosis in the HIV population has improved significantly due to the prevention and treatment of opportunistic infections (OIs). As a result, HIV infection is chronically manageable. In the preHAART era, the median survival time in the HIV population was 10 years, while, at present, 85% of patients survive more than 10 years.(Sepkowitz, 2001) In the pre-HAART era, most HIV-infected patients died of acquired immunodeficiency syndrome (AIDS). Recently, however, one-third of all such patients die of malignant tumor,(Bonnet et al., 2009) and deaths due to AIDS-defining cancers (ADCs), such as Kaposi’s sarcoma (KS), primary central nervous system lymphoma (PCNSL) and non-Hodgkin’s lymphoma (NHL), and invasive cervical carcinoma, which were defined by the Centers for Disease Control and Prevention (CDC), are decreasing. On the other hand, the number of deaths due to non-AIDS-defining cancers (NADCs) is increasing.(Engels et al., 2008, Silverberg et al., 2009) At present, in the population with HIV infection, lung cancer accounts for 5% of all deaths and 15% of all deaths by malignant tumors.(Bonnet et al., 2009) Of all of the NADCs, lung cancer is the most common,(Engels et al., 2006, Lavole et al., 2006, Patel et al., 2008) followed by breast cancer, soft tissue sarcoma, Hodgkin’s lymphoma (HL), penile cancer, lip cancer, and testicular seminoma.(Frisch et al., 2001) In 1984, Irwin et al. reported the first case with simultaneous HIV infection and lung cancer,(Irwin et al., 1984) and several dozen patients have since been reported in the United States and Europe. (Table. 1) The clinical demographics of lung cancer with HIV infection differ slightly from the general population and are characterized by younger age, advanced stage at diagnosis, and aggressive tumor extension. Thus, the prognosis of lung cancer in the HIV population is poorer than that of lung cancer in the general population.(Lavole et al., 2006) Moreover, patient fragility to treatment needs to be considered. In the general population, lung cancer is the most common cause of cancer death worldwide. Furthermore, in the last decade, there has been progress in lung cancer