title: Human immunodeficiency virus infection and non-small cell lung cancer: survival and toxicity of antineoplastic chemotherapy in a cohort study.
abstract: OBJECTIVE
  To describe factors associated with survival in human immunodeficiency virus (HIV)-infected subjects with non-small cell lung cancer (NSCLC) and analyze toxicities induced by cytotoxic chemotherapy and antiretroviral compounds.
  
  
  METHODS
  Retrospective analyses of HIV-infected subjects with NSCLC enrolled in the Dat'Aids cohort. A toxicity substudy included subjects treated by at least one cycle of cytotoxic chemotherapy.
  
  
  METHODS
  Survival was analyzed using Cox models. In the toxicity substudy, factors associated with grade 4 hematological toxicity of each episode of combination of antiretroviral drugs and cytotoxic chemotherapy were analyzed using marginal logistic regression models.
  
  
  RESULTS
  Fifty-two subjects were included in the study: 42 were men, median age was 48 years, 98% were smokers, with a median of 30 pack years, median CD4 was 300 cells/μl, and median survival time was 12 months. CD4 levels ≥200 cells/μl at NSCLC diagnosis (hazard ratio [HR] = 0.29, 95% confidence interval [CI] [0.10-0.89]), performance status less than 2 (HR = 0.32, 95% CI [0.15-0.68]) and highly active antiretroviral therapy (HR = 0.26, 95% CI [0.09-0.74]) were significantly associated with increased survival in the multivariable model. Forty subjects were included in the toxicity substudy, and 14 among 68 different combinations were complicated by a grade 4 hematological toxicity. Protease inhibitor use (odds ratio = 5.22, 95% CI [1.07-25.38]) was significantly associated with grade 4 hematological toxicity in the multivariable analyses.
  
  
  CONCLUSIONS
  In HIV-infected patients, CD4 levels at NSCLC diagnosis may be a predictive factor of survival. Use of highly active antiretroviral therapy during NSCLC chemotherapy is warranted, but protease inhibitors should be used with caution, as they may enhance severe hematological toxicities.
authors.affiliation: Infectious Diseases Department, CHRU Montpellier, Montpellier, France. a-makinson@chu-montpellier
authors.forename: Alain
authors.initials: A
authors.lastname: Makinson
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Tenon
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pujol
authors.forename: Clotilde
authors.initials: C
authors.lastname: Allavena
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Poizot-Martin
authors.forename: Xavier
authors.initials: X
authors.lastname: de la Tribonnière
authors.forename: André
authors.initials: A
authors.lastname: Cabié
authors.forename: Pascal
authors.initials: P
authors.lastname: Pugliese
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D004347:Drug Interactions; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000970:Antineoplastic Agents