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Individuals infected with the human immunodeficiency virus (HIV) appear to have a higher risk of lung cancer than the general population, due at least in part to a higher prevalence of smoking. A review of lung cancer and HIV was published in the journal Lung Cancer.

Individuals with HIV infections are known to be predisposed to cancers such as Kaposi’s sarcoma and non-Hodgkin’s lymphoma. Less attention has been paid, however, to cancers that may have a large impact on the HIV-infected population, but don’t have a clear link with the infection.

Studies have suggested that lung cancer may be a significant cause of death among individuals with HIV. Researchers in France recently summarized what is known about the frequency and characteristics of lung cancer in the HIV-infected population.

The impact of lung cancer in the HIV-infected population appears to have changed since the introduction of highly active antiretroviral treatments (HAART) in 1996. Some studies have suggested that the risk of lung cancer among HIV-infected individuals in the pre-HAART era was similar to the risk of the general population. More recent studies, however, suggest that the risk of lung cancer is twice as high (or higher) in HIV-infected individuals and that the risk may be greater in women than in men. The reasons for the increased frequency of lung cancer in the post-HAART era may include both longer life expectancy and a decline in deaths from AIDS (providing a greater opportunity to develop lung cancer).

Smoking is likely to account for at least some of the increased risk of lung cancer. Studies have reported notably higher prevalence of smoking in the HIV-infected population than in non-infected individuals of a similar age. One study, however, suggested that differences in smoking patterns do not explain all of the increased risk.

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Lung cancer in HIV-infected individuals shows similarities as well as differences with lung cancer in non-infected individuals:

  • On average, lung cancer occurs at a younger age in HIV-infected individuals (45 years vs. 62 years in the general population).
  • Roughly 85% of HIV-infected individuals who develop lung cancer are smokers; this is similar to what is observed in the general population.
  • HIV-related immunodeficiency is usually moderate at the time of lung cancer diagnosis.
  • A majority of lung cancer in HIV-infected individuals is diagnosed at an advanced stage (stage III or stage IV). This is similar to what is observed among non-infected individuals.
  • Non-small cell lung cancer is the most common type of lung cancer in both the HIV-infected and noninfected individuals.
  • Lung cancer survival appears to be worse in the HIV-infected population.

Given the link between smoking and lung cancer and the high prevalence of smoking in the HIV-infected population, the researchers conclude that HIV-infected individuals “must be informed of the risks of smoking and encouraged to stop.” The researchers also recommend additional studies of lung cancer treatment in the HIV-infected population in order to identify the most effective and least toxic approaches.

Reference: Lavolé A, Wislez M, Antoine M et al. Lung Cancer, a New Challenge in the HIV-Infected Population. Lung Cancer. 2006;51:1-11.

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