Lung cancer in HIV-infected patients: The experience of an urban clinic

Abstract

Background: Lung cancer is one of the most common non-AIDS-defining malignancies among HIV-infected patients. Recent studies suggest that lung cancer risk is 3 to 4 times higher in HIV-infected patients than in uninfected persons after adjusting for other factors such as smoking intensity and duration. Methods: A retrospective chart review (2002-2009) was conducted in our institution. An abstraction form was used to compile data that included demographics, T-cell count, and viral loads before and at the time of diagnosis, comordibities, smoking, and use of alcohol and drugs. Results: A total of 16 patients were found. Of these, 11 (69%) patients were male and 5 (31%) female. The average age at diagnosis was 49 years (range 36-54). The Majority of patients were African American (90%). Their average CD4 counts before and at the time of diagnoses were 241 and 211 cells/mm3, respectively. Their viral loads before and at the time of diagnosis ranged from <48 to 437 000 and <48 to 590 760 copies/mL, respectively. Adenocarcinoma was found in 67% of cases. The majority of cases (85%) were detected at advanced stages (IIIB or IV). Smoking was found in 100% of cases (average of 15-20 pack/year history), alcohol use in 70% of cases, and drug abuse in 50%. Conclusions: Lung cancer is very common in HIV-infected populations. It tends to occur at a young age, and it is usually diagnosed at very advanced stages (IIIB or IV). The main risk factors found in our study were extensive smoking history, young age, male sex, and potentially prolonged immunosuppression. Based on these results, an attempt to construct a high-risk group index might not be appropriate due to the limited number of cases studied and the need for further evaluation of the length of immunosuppression and the real impact of HIV RNA viral load in the development of lung cancer. © The Author(s) 2010.