LUNG-CANCER IN PATIENTS WITH HIV-INFECTION

Purpose: To identify and review the clinical characteristics and natur al history of lung cancer in HIV-seropositive patients. A secondary ob jective was to compare the clinical features of HIV-seropositive and H IV-indeterminate lung cancer cases at our institution. Patients and me thods: Sixteen patients with HIV infection and lung cancer were diagno sed between January 1988 and March 1995 at our institution and the cli nical records were reviewed. HIV-indeterminate lung cancer cases were identified by the Albany Medical Center Hospital (AMCH) Tumor Registry . A Medline database search of HIV infection/AIDS and lung cancer was undertaken through December 1994. The New York State Department of Hea lth (NYSDOH), Bureau of Cancer Epidemiology provided information on th e incidence of lung cancer among residents of New York State by county of residence. Case reports and series regarding the clinical features of HIV-seropositive patients with lung cancer were reviewed. A more f ocused comparison between HIV-seropositive and HIV-indeterminate male lung cancer cases between 35 and 54 years of age at our institution wa s performed. The following clinical variables were identified in our 1 6 patients and 109 cases extracted from available clinical reports: se x, age, year and county of residence at time of lung cancer diagnosis, cigarette smoking history, HIV risk behavior, CD4 count at time of lu ng cancer diagnosis, CDC classification of HIV disease, interval in mo nths from time of HIV seropositivity to lung cancer diagnosis, patholo gy and stage of lung cancer, performance status, treatment, response, and survival. Results: Lung cancer in HIV-seropositive patients is cha racterized by the following: a younger age at time of diagnosis when c ompared to HIV-indeterminate cases; the majority of cases occur in a b ackground of extensive cigarette smoking; over 80% of patients present with advanced stage of lung cancer (stage III and IV): up to 50% of c ases have asymptomatic to mildly symptomatic HIV infection with a medi an CD4 lymphocyte count of 233 per mu l; there is a predominance of ad enocarcinoma histopathology; and shortened survival when compared to H IV-indeterminate cases. Conclusion: Current reports of lung carcinoma in HIV-seropositive patients suggest that the natural history of this disease is different than in HIV-indeterminate cases. Lung cancer must be considered in the differential diagnosis of a solitary mass lesion on chest X-ray in HIV-seropositive patients.