Journal Article

HIV Infection Is Associated with an Increased Risk for Lung Cancer, Independent of Smoking

Gregory D. Kirk, Christian Merlo, Peter O'Driscoll, Shruti H. Mehta, Noya Galai, David Vlahov, Jonathan Samet and Eric A. Engels

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 1, pages 103-110
Published in print July 2007 | ISSN: 1058-4838
Published online July 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/518606
HIV Infection Is Associated with an Increased Risk for Lung Cancer, Independent of Smoking

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Background. Human immunodeficiency virus (HIV)–infected persons have an elevated risk for lung cancer, but whether the increase reflects solely their heavy tobacco use remains an open question.

Methods. The Acquired Immunodeficiency Syndrome (AIDS) Link to the Intravenous Experience Study has prospectively observed a cohort of injection drug users in Baltimore, Maryland, since 1988, using biannual collection of clinical, laboratory, and behavioral data. Lung cancer deaths were identified through linkage with the National Death Index. Cox proportional hazards regression was used to examine the effect of HIV infection on lung cancer risk, controlling for smoking status, drug use, and clinical variables.

Results. Among 2086 AIDS Link to the Intravenous Experience Study participants observed for 19,835 person-years, 27 lung cancer deaths were identified; 14 of the deaths were among HIV-infected persons. All but 1 (96%) of the patients with lung cancer were smokers, smoking a mean of 1.2 packs per day. Lung cancer mortality increased during the highly active antiretroviral therapy era, compared with the pre–highly active antiretroviral therapy period (mortality rate ratio, 4.7; 95% confidence interval, 1.7–16). After adjusting for age, sex, smoking status, and calendar period, HIV infection was associated with increased lung cancer risk (hazard ratio, 3.6; 95% confidence interval, 1.6–7.9). Preexisting lung disease, particularly noninfectious diseases and asthma, displayed trends for increased lung cancer risk. Illicit drug use was not associated with increased lung cancer risk. Among HIV-infected persons, smoking remained the major risk factor; CD4 cell count and HIV load were not strongly associated with increased lung cancer risk, and trends for increased risk with use of highly active antiretroviral therapy were not significant.

Conclusions. HIV infection is associated with significantly increased risk for developing lung cancer, independent of smoking status.

Journal Article.  4348 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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