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Lag time between HIV, lung cancer diagnosis shrinking
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BOSTON — In patients with HIV, lung cancer occurs at a younger age compared with the general population. In addition, the average time between HIV and lung cancer diagnoses decreased from 11 years to less than 3 years after 1997 and reasons for this finding remain unclear, according to Justine Cohen, DO.
"Many studies have been conducted to determine what causes lung cancer in patients with HIV; whether it's smoking, immunosuppression, chronic pulmonary inflammation, some sort of infection," Cohen, told HemOnc Today. "But no one's really looked at correlating the ages at which people are getting diagnosed with HIV and the age they are getting diagnosed with lung cancer. I wanted to look at that and see if it would give us any clues as to why this trend of lung cancer at a younger age and more lung cancer diagnoses exists."
Cohen, of the department of internal medicine at the University of Pennsylvania, and colleagues pooled data on more than 3,000 patients at the university to identify those with lung cancer included in the Center for AIDS Research database. From 1983 to 2011, 30 patients with AIDS had lung cancer; the average of HIV diagnosis was 40 and lung cancer diagnosis was 52.
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Lung cancer development occurred within an average of 11 years of initial HIV diagnosis. However, in recent years, the lag time between HIV and lung cancer diagnoses were substantially lower, demonstrating a decrease from 11 to less than 3 years after 1997, according to the results. Cohen said it is unclear whether patients are being diagnosed sooner or developing lung cancer sooner after HIV diagnosis.
"A lot more research needs to be done to explain the reasons for this. Though this is a really high risk smoking population, smoking alone can't account for this change," Cohen said. "So, it begs the question of whether there is more awareness in this population, or more increased utilization of medical facilities and medical awareness within this population. HAART therapy became available and was used a lot more in 1996 and 1997; is there a link between lung cancer and HAART? Or, are physicians hyper aware of lung cancer now so they are picking up on it more?"
Cohen added that this brings up a question of whether HIV patients need to be screened for lung cancer. Due to the high-risk nature of this population, they may be the ideal cohort for mandatory CT screening for lung cancer. However, she said, a larger study is vital before testing this theory is possible. - by Stacey L. Fisher
For more information:
- Cohen J. 437. Presented at: IDSA 49th Annual Meeting; Oct. 20-23, 2011; Boston.
Disclosure: Dr. Cohen reported no relevant financial disclosures.
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The growing recognition that HIV-infected persons are now at increasing risk for other chronic diseases leads us to consider if these should prompt changes in primary care approaches. As this paper acknowledges, some of these co-morbidities may be related to "life-style" issues such as higher rates of smoking in HIV-infected populations. Other factors may include HIV itself or side effects of HIV treatment. Teasing this apart will take more research but meanwhile, clinicians must be alert to non-HIV related problems including cancers and follow patients accordingly.
- Paul A. Volberding, MD
Professor and Vice Chair, UCSF Department of Medicine;
Chief, Medical Service SF Veterans Affairs Medical Center;
Co-Director, UCSF-GIVI Center for AIDS Research
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