HIV-associated lung cancer: Survival in an unselected cohort

Abstract

Background: Lung cancer is one of the most common non-AIDS-defining malignancies in HIV-infected patients. However, data on clinical outcome and prognostic factors are scarce. Methods: This was a national German multicentre, retrospective cohort analysis of all cases of lung cancer seen in HIV-infected individuals from 2000 through 2010. Survival was analyzed with respect to the use of antiretroviral therapy (ART), specific lung cancer therapies, and other potential prognostic factors. Results: A total of 72 patients (mean age 55.5 y, CD4 T-cells 383/μl) were evaluated in this analysis. At time of lung cancer diagnosis, 86% were on ART. Of these, 79% had undetectable HIV-1 RNA (< 50 copies/ml) for a mean duration of 4.0 y. All but 1 patient were current or former heavy smokers (mean 42 package y). The median estimated overall survival was 1.08 y, with a 2-y overall survival of 24%. The prognosis did not improve during the observation time. A limited lung cancer stage of I–IIIA was associated with better overall survival when compared with the advanced stages IIIb/IV (p = 0.0003). Other factors predictive of improved overall survival were better performance status, CD4 T-cells > 200/μl, and a non-intravenous drug use transmission risk for HIV. Conclusions: Currently, most cases of lung cancer occur in the setting of limited immune deficiency and a long-lasting viral suppression. As in HIV-negative cases, the clinical stage of lung cancer is highly predictive of survival, and long-term overall survival can only be achieved at the limited stages. The still high mortality underscores the importance of smoking cessation strategies in HIV-infected patients.

Keywords::

• Lung carcinoma
• survival
• HIV infection
• mortality
• antiretroviral therapy

Acknowledgements

We would like to thank Axel Adam (Hamburg), Philip Aries (Hamburg), F. Engelhardt (Bonn), Stefan Esser (Essen), Stefan Hansen (Hamburg), Martin Hower (Dortmund), Birgit Mueck (Munich), Ramona Pauli (Munich), Pia Schenk-Westkamp (Essen), Carl-Knud Schewe (Hamburg), Barbara Sonntag (Munich), Gunnar Urban (Berlin), Jan van Lunzen (Hamburg), and Carmen Zedlack (Berlin) for help in collecting the data. We also thank Cinnamon N. Hunter (Mannheim) for help in preparing the manuscript.

Declaration of interest: Frankfurt University Hospital received a NEAT integration grant (funded by the European Union's 6^th Framework program, contract number LSHP-CT-2006-037570). The authors declare no conflicts of interest.

This study was initiated by the “Klinische Arbeitsgemeinschaft AIDS Deutschland”, a sub-section of the German AIDS Society.