title: Human immunodeficiency virus-associated lung cancer in the era of highly active antiretroviral therapy.
abstract: BACKGROUND
  Lung cancer is the leading cause of death among non-acquired immunodeficiency syndrome (AIDS)-defining malignancies. Because highly active antiretroviral therapy (HAART) has improved the survival of patients with human immunodeficiency virus (HIV), the authors evaluated lung cancer outcomes in the HAART era.
  
  
  METHODS
  HIV-positive patients who were diagnosed with lung cancer at the authors' institution during the HAART era (1995-2008) were analyzed. Patient charts were reviewed for clinical and laboratory data. The CD4 count at diagnosis was treated as a continuous variable and subcategorized into distinct variables with 3 cutoff points (50 cells/mL, 200 cells/mL, and 500 cells/mL). Pearson correlation coefficients were estimated for each covariate studied. Survival was determined by using the Kaplan-Meier method.
  
  
  RESULTS
  Of 80 patients, 73 had nonsmall cell lung cancer. Baseline characteristics were as follows: median patient age, 52 years; male, 80%; African Americans, 84%; injection drug users, 25%; smokers, 100%; and previous exposure to antiretroviral agents, 55%. At the time of cancer diagnosis, the mean CD4 count was 304 cells/mL, and the mean viral load was 82,420 copies/mL. The latency between HIV diagnosis and lung cancer diagnosis was significantly shorter among women (4.1 years vs 7.7 years; P = .02), and 71% of patients received anticancer therapy. The 1-year and 3-year survival rates for stage IIIB/IV were 25% and 0%, respectively. Grade 3/4 toxicities occurred in 60% of patients who received chemoradiation versus 36% of patients who received chemotherapy. Cancer-related survival was better for patients with CD4 counts >200 cells/mL (P = .0298) and >500 cells/mL (P = .0076).
  
  
  CONCLUSIONS
  The latency from diagnosis of HIV to lung cancer was significantly shorter for women. Although outcomes for patients with lung cancer who have HIV remain poor, a high CD4 count was associated with improved lung cancer-related survival.
authors.affiliation: Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Suchita
authors.initials: S
authors.lastname: Pakkala
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Taofeek K
authors.initials: TK
authors.lastname: Owonikoko
authors.forename: Clifford
authors.initials: C
authors.lastname: Gunthel
authors.forename: Johann R
authors.initials: JR
authors.lastname: Brandes
authors.forename: Nabil R
authors.initials: NR
authors.lastname: Saba
authors.forename: Dong M
authors.initials: DM
authors.lastname: Shin
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.forename: Fadlo R
authors.initials: FR
authors.lastname: Khuri
authors.forename: Suresh S
authors.initials: SS
authors.lastname: Ramalingam
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged