title: Delayed diagnosis and elevated mortality in an urban population with HIV and lung cancer: implications for patient care.
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.
authors.affiliation: Johns Hopkins Hospital, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA. mabrock@jhmi.edu
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
authors.forename: Richard F
authors.initials: RF
authors.lastname: Heitmiller
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Baylin
authors.forename: James G
authors.initials: JG
authors.lastname: Herman
authors.forename: Julie R
authors.initials: JR
authors.lastname: Brahmer
mesh_terms: D000328:Adult; D000368:Aged; D015142:Baltimore; D018791:CD4 Lymphocyte Count; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population