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Spierling A, Smith DA, Kikano EG, Rao S, Vos D, Tirumani SH, Ramaiya NH. Chest CT Findings in Patients with HIV Presenting to the Emergency Department: A Single Institute Experience. Curr Probl Diagn Radiol 2023; 52:110-116. [PMID: 36333220 DOI: 10.1067/j.cpradiol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to analyze chest CT imaging findings and relevant clinical factors in patients with HIV presenting to the emergency department (ED). MATERIALS AND METHODS A retrospective review was performed to identify patients with HIV who received chest CT imaging evaluation in the acute ED setting. Analyzed patients included adults with a known diagnosis of HIV who presented to the ED at a single tertiary care center between 2004 and 2020 and received chest CT imaging. Chest CT findings were assessed by 2 radiologist readers, and relevant clinical data were gathered. Statistical analysis was performed to determine if imaging and clinical factors demonstrate significant associations with CD4 count, viral load, and antiretroviral therapy status. RESULTS A total of 113 patients with HIV were identified who presented to the ED and underwent chest CT imaging evaluation (mean age 47 ± 11 years). Frequently detected chest CT findings included infectious pneumonia (24%), malignancy (11%), pleural effusion (17%), pericardial effusion (13%), and pulmonary embolism (4%). CD4 count, viral load, and active retroviral therapy demonstrated statistically significant associations with a number of key imaging and clinical factors, including presence of pneumonia, malignancy, average length of hospital admission, and survival. CONCLUSION Patients with HIV present with a wide range of imaging findings when presenting in the acute ED setting. CD4 count, viral load, and active retroviral therapy status demonstrate statistically significant associations with multiple key imaging findings and clinical factors. Chest CT plays an integral role in the clinical management of this unique patient population.
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Affiliation(s)
- Angela Spierling
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Daniel A Smith
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH.
| | - Elias G Kikano
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Sanjay Rao
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Derek Vos
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sree H Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH
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Wang L, Song Y. [Individualized Comprehensive Therapy for the Lung Cancer Patients
with HIV Infection]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:327-332. [PMID: 29587918 PMCID: PMC5973341 DOI: 10.3779/j.issn.1009-3419.2018.04.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
背景与目的 观察HIV合并肺癌患者临床特征、临床分期、病理学类型、治疗方案及临床效果,为HIV合并肺癌的个体化综合治疗提供指导。 方法 通过回顾性分析我科收治的53例HIV合并肺癌患者,其中47例非小细胞肺癌(non-small cell lung cancer, NSCLC),6例小细胞肺癌(small cell lung cancer, SCLC),24例接受手术联合化疗,22例接受单纯化疗,7例放弃治疗;其中Ⅰ期-Ⅲ期28例,Ⅳ期25例;28例Ⅰ期-Ⅲ期患者中手术联合化疗24例,2例放弃治疗,2例合并严重慢性阻塞性肺疾病无法耐受手术接受化疗。根据患者治疗前高效抗逆转录病毒治疗(highly active anti-retroviral therapy, HAART)治疗情况,将治疗前接受HAART治疗的视为观察组(n=27),未接受HAART治疗患者放入对照组(n=19)。对比两组生存率情况,分析患者不同治疗方案的生存率及其独立影响因素。 结果 53例HIV合并肺癌患者中接受治疗的46例,观察组与对照组1年生存率、2年生存率无组间差异;Ⅰ期-Ⅲ期生存期患者1年生存率为76.0%,2年生存率为60.0%。Ⅳ期患者1年生存率为13.6%,2年生存率为0%。24例手术联合化疗患者1年生存率83.3%,2年生存率62.5%;22例接受单纯化疗的患者1年生存率18.0%,2年生存率为0%。 结论 HIV合并肺癌患者经不同的个体化综合治疗可以提高患者生存率,早期手术联合化疗效果显著。
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Affiliation(s)
- Lin Wang
- Department of Cerebral Surgery Public Health Clinical Center Affiliated, Shanghai 201508, China
| | - Yanzheng Song
- Department of Cerebral Surgery Public Health Clinical Center Affiliated, Shanghai 201508, China
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Cheng Z, Shan F, Liu J, Shi Y, Zhang Z, Wu G. Clinical and computed tomography findings in Chinese lung cancer patients with HIV infection: A multi-center study. Thorac Cancer 2017; 8:238-245. [PMID: 28294549 PMCID: PMC5415480 DOI: 10.1111/1759-7714.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The study was conducted to investigate clinical and computed tomography (CT) features in Chinese lung cancer patients with human immunodeficiency virus (HIV). METHODS Forty consecutive lung cancer patients with HIV were included. Clinical data were collected, and CT features were reviewed and measured. The factors associated with stages of cancer and the CT features with opportunistic pulmonary infections (OPIs) were also analyzed. RESULTS Thirty-four of the patients were men (85%), and the mean age was 57.5 years. The mean CD4 count was 288 cells/μL, and 23 patients received highly active antiretroviral therapy. OPIs were common (50%). The major histological type (85%) was non-small cell lung cancer (NSCLC), and 15 NSCLC patients (44%) were in stages IIIb and IV. NSCLC patients with an OPI were more common in the advanced stages compared with those without an OPI (P = 0.04). There were no significant differences in advanced and non-advanced stages in terms of CD4 level, highly active antiretroviral therapy, and smoking (P = 0.31, P = 1.00; P = 0.49, respectively). The average size of tumors was 4.5 cm. Irregularly shaped or larger sized tumors were associated with OPIs (P = 0.03, P = 0.04, respectively). CONCLUSIONS The persistence of locally irregular and large lesions in middle-aged men with HIV and a history of OPIs should be an alert for lung cancer, and clinical management is needed.
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Affiliation(s)
- Zenghui Cheng
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of Radiology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Headmaster's Office, Fudan University, Shanghai, China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guowei Wu
- Department of Radiology, Guangxi Longtan Hospital, Liuzhou, China
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Abstract
INTRODUCTION Since the advent of antiretroviral therapy (ART), non-infectious pulmonary disorders have become common comorbidities in the human immunodeficiency virus (HIV) positive population. Clinicians caring for those with HIV disease should be aware of the prevalence of non-infectious pulmonary disorders. A comprehensive understanding is required to diagnosis and manage these syndromes appropriately. Areas covered: This review focuses on the epidemiology, risk factors, pathogenesis, clinical feature and diagnosis, and treatment of HIV-related chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary hypertension. Expert Commentary: The prevalence of COPD in the HIV population is frequent and requires appropriate diagnosis and treatment. HIV-positive individuals with lung cancer carry a poorer prognosis and require early diagnosis and treatment. A complex condition exists with pulmonary hypertension in the HIV population and requires a high degree of clinical suspicion for early diagnosis.
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Affiliation(s)
- Choua Thao
- a Section of Pulmonary and Critical Care Medicine , MedStar Washington Hospital Center , Washington , DC , USA
| | - Andrew F Shorr
- a Section of Pulmonary and Critical Care Medicine , MedStar Washington Hospital Center , Washington , DC , USA.,b Medical Intensive Care Unit , MedStar Washington Hospital Center , Washington , DC , USA
| | - Christian Woods
- b Medical Intensive Care Unit , MedStar Washington Hospital Center , Washington , DC , USA.,c Sections of Infectious Diseases and Pulmonary/Critical Care Medicine , MedStar Washington Hospital Center , Washington , DC , USA.,d Education, Section of Critical Care Medicine , MedStar Washington Hospital Center , Washington , DC , USA
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Yu X, Shen J, Qu Y, Cao Y, Lu Z, Liao M, Wu J. Radiological features of AIDS complicated by pulmonary cryptococcosis: Literature review and a report of 10 cases. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jrid.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Epidemiological evidence suggests that HIV-infected individuals are at increased risk of lung cancer, but no data exist because large computed tomography (CT) screening trials routinely exclude HIV-infected participants. METHODS From 2006 to 2013, we conducted the world's first lung cancer screening trial of 224 HIV-infected current/former smokers to assess the CT detection rates of lung cancer. We also used 130 HIV-infected patients with known lung cancer to determine radiographic markers of lung cancer risk using multivariate analysis. RESULTS Median age was 48 years with 34 pack-years smoked. During 678 person-years, one lung cancer was found on incident screening. Besides this lung cancer case, 18 deaths (8%) occurred, but none were cancer related. There were no interim diagnoses of lung or extrapulmonary cancers. None of the pulmonary nodules detected in 48 participants at baseline were diagnosed as cancer by study end. The heterogeneity of emphysema across the entire lung as measured by CT densitometry was significantly higher in HIV-infected subjects with lung cancer compared with the heterogeneity of emphysema in those without HIV (p ≤ 0.01). On multivariate regression analysis, increased age, higher smoking pack-years, low CD4 nadir, and increased heterogeneity of emphysema on quantitative CT imaging were all significantly associated with lung cancer. CONCLUSIONS Despite a high rate of active smoking among HIV-infected participants, only one lung cancer was detected in 678 patient-years. This was probably because of the young age of participants suggesting that CT screening of high-risk populations should strongly consider advanced age as a critical inclusion criterion. Future screening trials in urban American must also incorporate robust measures to ensure HIV patient compliance, adherence, and smoking cessation.
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PATHOLOGIE INFECTIEUSE. IMAGERIE THORACIQUE 2013. [PMCID: PMC7156015 DOI: 10.1016/b978-2-294-71321-7.50016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hooker CM, Meguid RA, Hulbert A, Taylor JT, Shin J, Wrangle J, Rodgers K, Lee B, Laskshmanan S, Brown T, Meneshian A, Sussman M, Keruly J, Moore RD, Yang SC, Brock MV. Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer. Ann Thorac Surg 2012; 93:405-12. [PMID: 22269705 DOI: 10.1016/j.athoracsur.2011.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/04/2011] [Accepted: 11/07/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND The purpose of this study was to assess the effect of human immunodeficiency virus (HIV) infection on postoperative survival among non-small cell lung cancer (NSCLC) patients. METHODS A retrospective cohort study compared 22 HIV-infected lung cancer patients to 2,430 lung cancer patients with HIV-unspecified status who underwent resection at Johns Hopkins Hospital from 1985 to 2009. Subcohort comparative analyses were performed using individual matching methods. RESULTS Thirty-day mortality rates did not differ between HIV-infected and HIV-unspecified patients. Survival rates for HIV-infected lung cancer patients were significantly shorter than for HIV-unspecified patients (median, 26 versus 48 months; p=0.001). After adjustment, the relative hazard of mortality among HIV-infected NSCLC patients was more than threefold that of HIV-unspecified patients (adjusted hazard ratio, 3.08; 95% confidence interval: 1.85 to 5.13). When additional surgical characteristics were modeled in a matched subcohort, the association remained statistically significant (adjusted hazard ratio, 2.31; 95% confidence interval: 1.11 to 4.81). Moreover, HIV-infected lung cancer patients with CD4 counts less than 200 cells/mm3 had shortened median survival compared with patients whose CD4 counts were 200 cells/mm3 or greater (8 versus 40 months; p=0.031). Postoperative pulmonary and infectious complications were also elevated in the HIV-infected group (p=0.001 and p<0.001, respectively). After surgery, median time to cancer progression was shorter among HIV-infected patients (20.4 months) versus HIV-unspecified patients (p=0.061). CONCLUSIONS The HIV-infected NSCLC patients have more postoperative complications, rapid progression to disease recurrence, and poorer postoperative survival. Optimizing immune status before surgery and careful patient selection based on diffusion capacity of lung for carbon monoxide may improve patient outcomes.
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Affiliation(s)
- Craig M Hooker
- Department of Oncology, Johns Hopkins School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Mani D, Haigentz M, Aboulafia DM. Lung cancer in HIV Infection. Clin Lung Cancer 2012; 13:6-13. [PMID: 21802373 PMCID: PMC3256276 DOI: 10.1016/j.cllc.2011.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/14/2011] [Accepted: 05/23/2011] [Indexed: 12/20/2022]
Abstract
Lung cancer is the most prevalent non-AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Providence Sacred Heart Medical Center, Spokane, WA 98111, USA
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Abstract
Malignancies account for more than a third of all deaths in human immunodeficiency virus (HIV)-positive patients. Although acquired immunodeficiency syndrome-related mortality is decreasing with the introduction of effective antiretroviral therapy, the incidence of lung cancer in patients with HIV remains high. Lung cancer has now become the leading cause of mortality among the nonacquired immunodeficiency syndrome defining malignancies. Within the HIV population, the incidence of lung cancer is estimated to be approximately 2 to 4 times that of the general population. Often these patients present with advanced disease (stage III or IV) at a younger age and have an inferior overall survival, when compared with non-HIV patients. Development of lung cancer in patients with HIV has been linked to various factors including immunosuppression, CD4 count, viral load, and smoking. This article reviews the impact of HIV on the incidence, risk factors, clinical presentation, and treatment of lung cancer.
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Ruiz M. Lung cancer in HIV-infected patients: the experience of an urban clinic. ACTA ACUST UNITED AC 2010; 9:214-7. [PMID: 20798400 DOI: 10.1177/1545109710373279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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/mm( 3), 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.
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Affiliation(s)
- Marco Ruiz
- Department of Medicine, Section of Infectious Diseases and Geriatric Medicine, Louisiana State University, New Orleans, LA, USA.
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Levine AM, Seaberg EC, Hessol NA, Preston-Martin S, Silver S, Cohen MH, Anastos K, Minkoff H, Orenstein J, Dominguez G, Watts DH. HIV as a risk factor for lung cancer in women: data from the Women's Interagency HIV Study. J Clin Oncol 2010; 28:1514-9. [PMID: 20177022 DOI: 10.1200/jco.2009.25.6149] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prior reports of an increased risk of lung cancer in HIV-infected individuals have not always included control groups, nor considered other risk factors such as tobacco exposure. We sought to determine the role of HIV infection and highly active antiretroviral therapy (HAART) on lung cancer incidence in 2,651 HIV-infected and 898 HIV-uninfected women from the Women's Interagency HIV Study (WIHS). METHODS A prospective study of the incidence rates of lung cancer was conducted, with cases identified through medical records, death certificates, and state cancer registries. Standardized incidence ratios (SIRs) were calculated to compare lung cancer incidence among HIV-infected and uninfected WIHS participants, with population-based expectations using the Surveillance, Epidemiology, and End Results registry. Behavioral characteristics in the WIHS were compared to US women by age and race adjusting the population-based data from the National Health and Nutritional Examination Survey (NHANES) III. RESULTS Incidence rates of lung cancer were similar among HIV-infected and uninfected WIHS women. Lung cancer SIRs were increased in both HIV-infected and -uninfected women compared with population expectations, but did not differ by HIV status. Among HIV-infected women, lung cancer incidence rates were similar in pre-HAART and HAART eras. All WIHS women with lung cancer were smokers; the risk of lung cancer increased with cumulative tobacco exposure. WIHS women were statistically more likely to smoke than US women studied in NHANES III. CONCLUSION HIV infection is strongly associated with smoking behaviors that increase lung cancer risk. The role of HIV itself remains to be clarified.
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Cadranel J, Garfield D, Lavolé A, Wislez M, Milleron B, Mayaud C. Lung cancer in HIV infected patients: facts, questions and challenges. Thorax 2006; 61:1000-8. [PMID: 17071836 PMCID: PMC2121163 DOI: 10.1136/thx.2005.052373] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIDS related mortality has fallen sharply in industrialised countries since 1996 following the introduction of highly active antiretroviral therapy. This has been accompanied by an increase in the proportion of deaths attributable to non-AIDS defining solid tumours, especially lung cancer. The risk of developing lung cancer seems to be higher in HIV infected subjects than in the general population of the same age, partly because the former tend more frequently to be smokers and, especially, intravenous drug users. The carcinogenic role of the antiretroviral nucleoside drugs and their interaction with smoking needs to be examined. Interestingly, there is no clear relationship between the degree of immunosuppression and the risk of lung cancer, so the reason for the increased risk is unknown. The mean age of HIV infected patients at the time of lung cancer diagnosis is 45 years and most are symptomatic. Lung cancer is diagnosed when locally advanced or metastatic (stage III-IV) in 75-90% of cases, similar to patients with unknown HIV status. Adenocarcinoma is the most frequent histological type. The prognosis is worse in HIV infected patients than in the general lung cancer population. Efficacy and toxicity data for chemotherapy and radiation therapy are few and imprecise. Surgery remains the treatment of choice for localised disease in patients with adequate pulmonary function and general good health, regardless of immune status. Prospective clinical trials are needed to define the optimal detection and treatment strategies for lung cancer in HIV infected patients.
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Affiliation(s)
- J Cadranel
- Service de Pneumologie et Réanimation Respiratoire, Hôpital Tenon, 4 rue de la Chine 75970, Paris cedex 20, France.
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Brock MV, Hooker CM, Engels EA, Moore RD, Gillison ML, Alberg AJ, Keruly JC, Yang SC, Heitmiller RF, Baylin SB, Herman JG, Brahmer JR. Delayed Diagnosis and Elevated Mortality in an Urban Population With HIV and Lung Cancer. J Acquir Immune Defic Syndr 2006; 43:47-55. [PMID: 16936558 DOI: 10.1097/01.qai.0000232260.95288.93] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lung cancer is more common in HIV-infected patients than in the general population. We examined how effectively lung cancer was being diagnosed in our HIV-infected patients. METHODS Retrospective study assessing clinical diagnosis of lung cancer in HIV-infected patients at Johns Hopkins Hospital between 1986 and 2004. RESULTS Ninety-two patients were identified. Compared to HIV-indeterminate patients (n=4973), HIV-infected individuals were younger with more advanced cancer. CD4 counts and HIV-1 RNA levels indicated preserved immune function. Mortality was higher in HIV-infected patients, with 92% dying of lung cancer (hazard ratio, 1.57; 95% confidence interval, 1.25-1.96), compared to HIV-uninfected patients. Advanced stage and black race were associated with worse survival. After adjustment for these factors, HIV infection was not associated with increased mortality (hazard ratio, 1.04; 95% confidence interval, 0.83-1.32). Of 32 patients followed in our HIV clinic, 60% of chest radiographs had no evidence of neoplasm within 1 year of diagnosis compared to only 1 (4%) of 28 chest computed tomography scans. Nonspecific infiltrates were observed in 9 patients in the same area that cancer was subsequently diagnosed. CONCLUSIONS HIV-infected lung cancer patients have shortened survival mainly due to advanced stage. Low clinical suspicion and overreliance on chest radiographs hindered earlier detection. Aggressive follow-up of nonspecific pulmonary infiltrates in these patients is warranted.
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Affiliation(s)
- Malcolm V Brock
- Johns Hopkins Hospital, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA.
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Grubb JR, Moorman AC, Baker RK, Masur H. The changing spectrum of pulmonary disease in patients with HIV infection on antiretroviral therapy. AIDS 2006; 20:1095-107. [PMID: 16691060 DOI: 10.1097/01.aids.0000226949.64600.f9] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lavolé A, Wislez M, Antoine M, Mayaud C, Milleron B, Cadranel J. Lung cancer, a new challenge in the HIV-infected population. Lung Cancer 2005; 51:1-11. [PMID: 16300854 DOI: 10.1016/j.lungcan.2005.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 08/29/2005] [Accepted: 09/06/2005] [Indexed: 11/17/2022]
Abstract
HIV infection predisposes patients to AIDS-defining malignancies, some of which, such as Kaposi's sarcoma and non-Hodgkin lymphoma, can affect the lungs. In 1996, AIDS-related mortality started to fall sharply in industrialized countries following the introduction of highly active antiretroviral treatments (HAART). This was accompanied by an increase in the proportion of deaths attributable to non AIDS-defining solid tumors, and especially lung cancer (LC). The increased risk of LC relative to the general population of the same age seems to be due partly to a higher prevalence of smoking among HIV-infected subjects. The average age of HIV-infected patients at LC diagnosis is about 45 years. Most patients are symptomatic at diagnosis and have only mild or moderate immunosuppression. LC is diagnosed when it is locally advanced or metastatic (stages III-IV) in 75-90% of cases, as in patients with unknown HIV serostatus. Adenocarcinoma is the most frequent histologic type. The prognosis of LC is poorer in HIV-infected patients than in the general population. Data on the efficacy and toxicity of chemotherapy in this setting are rare and rather imprecise. Surgery remains the reference treatment for localized disease in patients with adequate functional status and general health, regardless of their immune status. Prospective clinical trials are needed to define the optimal LC treatment strategies in HIV-infected patients.
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Affiliation(s)
- Armelle Lavolé
- Service de Pneumologie et Réanimation Respiratoire, AP-HP Hôpital Tenon, 4 rue de la Chine 75970, and UPRES EA 3493, Faculté Saint-Antoine, Université Paris VI, Paris, France
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Abstract
PURPOSE OF REVIEW Aerodigestive (lung, head and neck) cancers are among the most prevalent and deadly neoplasms worldwide, and the incidence rates are rising. Given the improvements in life expectancy of persons with HIV/AIDS when treated with highly active antiretroviral agents, persons with HIV infection are therefore increasingly likely to develop these malignancies. This chapter focuses on the epidemiology of these malignancies and reviews the most recent literature and current understanding of the causes and treatment of these malignancies in HIV-positive populations. RECENT FINDINGS Aerodigestive neoplasms in patients with HIV infection are associated with younger age at diagnosis, cigarette smoking, advanced stage at presentation, and a more aggressive clinical course. The causes of these cancers, aside from the traditional risk factors of tobacco and alcohol exposure, are not clear. Although these neoplasms are non-AIDS defining, factors that might contribute to risk include HIV-related immunosuppression and co-infection with high-risk human papillomavirus subtypes. SUMMARY With continued improvements in therapies for HIV, the expected increase in incidence and mortality of persons with HIV infection from aerodigestive malignancies will likely become a major public health concern. Given the younger age of HIV-infected patients with these malignancies and the apparently higher rates of smoking among HIV-positive individuals, aggressive smoking cessation efforts should be directed to this high-risk population.
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Affiliation(s)
- Missak Haigentz
- Departments of Medicine and Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Hoffheimer Room 100, Bronx, NY 10467, USA.
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Spano JP, Massiani MA, Bentata M, Rixe O, Friard S, Bossi P, Rouges F, Katlama C, Breau JL, Morere JF, Khayat D, Couderc LJ. Lung cancer in patients with HIV Infection and review of the literature. Med Oncol 2004; 21:109-15. [PMID: 15299182 DOI: 10.1385/mo:21:2:109] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2003] [Accepted: 01/21/2004] [Indexed: 11/11/2022]
Abstract
BACKGROUND The improved survival of patients since the use of highly active antiretroviral treatments has lead to the reporting of non-AIDS defining tumors, such as lung cancer. METHODS Analysis of the records of 22 HIV-infected patients with lung cancer (LC) diagnosed in three hospitals located in the Paris area (France). RESULTS Twenty-one patients were smokers. The patients (86% male, 14% female) had a median age of 45 yr (range, 33-64 yr). Risk factors for HIV infection were intravenous drug use in 5 patients, homosexual transmission in 10 patients, and heterosexual transmission in 7 patients. At diagnosis of LC, seven patients had previously developed a CDC-defined AIDS manifestation, the median CD4 cell count was 364/mm3 (range 20-854/mm3) and median HIV1 RNA viral load was 3000 copies/mL. The most frequent histological subtype was squamous cell carcinoma (11 cases). A stage III-IV disease was observed in 75% of the patients. Only one patient had a small-cell lung carcinoma. Twenty-one patients received combined specific therapy, of which six patients underwent surgery for the LC. The median overall survival was 7 mo. No opportunistic infections occurred during LC therapy. CONCLUSIONS LC occurs at a young age in HIV-infected smokers. LC is not associated with severe immunodeficiency. The prognosis is poor because of their initial extensive disease and a poor response to therapy. However, surgery appears to improve outcome in much the same way as in the general population.
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Affiliation(s)
- Jean-Philippe Spano
- Pitie-Salpetriere Hospital, Department of Medical Oncology, bld de I'Hopital, 75013 Paris, France.
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20
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Abstract
PURPOSE OF REVIEW Since the introduction of highly active antiretroviral therapy (HAART), the natural history of human immunodeficiency virus (HIV) infection has changed. Early in the acquired immunodeficiency syndrome (AIDS) epidemic, epidemiologic studies showed that HIV-infected patients were at higher risk for developing specific AIDS-defining malignancies. More recent studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. We review the most recent data regarding clinical presentation, pathology, and treatment outcomes for these non-AIDS-defining malignancies. RECENT FINDINGS Recent large cohort studies linking HIV/AIDS databases to cancer registries have shown that HIV-infected patients are also at higher risk of developing non-AIDS-defining malignancies. Besides anal cancer and Hodgkin disease, the cohort studies have identified other malignancies that appear to occur at a higher rate in the HIV-infected population as compared with the general population. These malignancies include lung cancer, skin cancer, germ cell tumors, leiomyosarcomas, cancers of the head and neck, conjunctival cancer, multiple myeloma, and leukemias. SUMMARY As the epidemiology of non-AIDS-defining malignancies continues to evolve, it is unclear whether the appropriate treatments and outcomes for these or other malignancies are changed for HIV-infected patients treated with HAART.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA
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Bower M, Powles T, Nelson M, Shah P, Cox S, Mandelia S, Gazzard B. HIV-related lung cancer in the era of highly active antiretroviral therapy. AIDS 2003; 17:371-5. [PMID: 12556691 DOI: 10.1097/00002030-200302140-00011] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address the impact of highly active antiretroviral therapy (HAART) on the incidence and outcome of patients with HIV-related lung cancer. DESIGN AND SUBJECTS Patients with HIV-related lung cancer were identified from a prospective HIV data base of 8400 patients diagnosed between 1986 and 2001. Patients diagnosed with HIV-related lung cancer before 1996 were in the pre-HAART cohort whereas the remainder were in the post-HAART cohort. METHODS The incidence of HIV-related lung cancer in the pre- and post-HAART cohorts was compared with the age and sex-matched population of south east England. Clinicopathological features, treatments and outcomes were also recorded. RESULTS The incidence of HIV-related lung cancer increased from 0.8 (95% CI 0.2-3.2)/10(5) patient-years follow-up in the pre-HAART era to 6.7 (95% CI 3.1-13.9)/10(5) patient-years follow-up in the post-HAART era. The age and sex-matched incidence of lung cancer in south east England was 0.75 (95% CI 0.63-0.87)/10(5) patient-years, suggesting that HIV-related lung cancer only occurred more frequently in the post-HAART era (relative risk 8.93, 95% CI 4.92-19.98). The patient characteristics and outcomes were similar in the pre- and post-HAART eras, although the time interval between testing HIV positive and developing HIV-related lung cancer was longer in post-HAART patients. CONCLUSION In this study HIV-related lung cancer occurred more frequently in the post-HAART era, when compared with the HIV-negative population. Unfortunately, the outcome of these patients remains poor despite HAART.
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Affiliation(s)
- Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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22
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Abstract
Pulmonary disorders remain an important complication of HIV infection, even in the current era of potent antiretroviral therapy. Using an integrated approach that combines radiographic pattern recognition with knowledge of a patient's clinical symptoms, laboratory data, immune status level, demographic information, and drug therapy can enhance the interpretation of imaging studies in HIV-infected patients. Although chest radiography remains the mainstay of imaging the HIV-positive patient with respiratory symptoms, CT plays an increasingly important secondary role in selected cases.
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Affiliation(s)
- Phillip M Boiselle
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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Vaccher E, Spina M, Tirelli U. Clinical aspects and management of Hodgkin's disease and other tumours in HIV-infected individuals. Eur J Cancer 2001; 37:1306-15. [PMID: 11423262 DOI: 10.1016/s0959-8049(01)00122-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As the AIDS epidemic advances, the spectrum of malignancies encountered is expanding. Several non-AIDS defining cancers, i.e. Hodgkin's disease (HD), anal and testicular cancer, are increasing in incidence in HIV-infected patients. The widespread use of highly active antiretroviral therapy (HAART) in industrialised countries has resulted in substantial improvement in the survival of HIV-infected patients. It is likely that in the future, cancers associated with long-term mild immune suppression will occur at an increased rate in long-term survivors of HIV infection. The natural history of the majority of non-AIDS defining tumours differs from that of the general population. Unusual aspects of tumour localisation, growth behaviour and therapeutical responses distinguish tumours in patients with HIV infection from those without. This paper reviews the most relevant data on the epidemiology, pathology, clinical features and treatment of the most frequently reported non-AIDS defining tumours, i.e. HD, lung, testicular and skin cancers.
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Affiliation(s)
- E Vaccher
- Division of Medical Oncology A, Centro di Riferimento Oncologico, IRCCS, Istituto Nazionale Tumori, Via Pedemontana Occ. 12, 33081 (PN), Aviano, Italy.
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Aviram G, Fishman JE, Schwartz DS. Metachronous primary carcinomas of the lung in an HIV-infected patient. AIDS Patient Care STDS 2001; 15:297-300. [PMID: 11445011 DOI: 10.1089/108729101750279669] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Studies have suggested that human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients have an increased risk of developing primary lung cancer, with a poor prognosis. We report a 59-year-old HIV-seropositive man who developed two metachronous primary bronchogenic carcinomas with different histologic features. The initial tumor was cured after early diagnosis and resection, with subsequent development of a contralateral tumor 6 years later. The case emphasizes that early diagnosis and treatment of lung cancer in HIV/AIDS patients should be sought as they may improve their short-term prognosis. However, because of their immunocompromised state, extended survival is still limited by a higher likelihood of developing subsequent malignancies.
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Affiliation(s)
- G Aviram
- Department of Radiology, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, Florida 33136-1094, USA
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