title: HIV as an independent risk factor for incident lung cancer.
abstract: BACKGROUND
  It is unclear whether the elevated rate of lung cancer among HIV-infected persons is due to biological effects of HIV, surveillance bias, or excess smoking. We compared the incidence of lung cancer between HIV-infected and demographically similar HIV-uninfected patients, accounting for smoking and stage of lung cancer at diagnosis.
  
  
  METHODS
  Data from the Veterans Aging Cohort Study Virtual Cohort were linked to data from the Veterans Affairs Central Cancer Registry, resulting in an analytic cohort of 37,294 HIV-infected patients and 75,750 uninfected patients.
  
  
  METHODS
  We calculated incidence rates of pathologically confirmed lung cancer by dividing numbers of cases by numbers of person-years at risk. We used Poisson regression to determine incidence rate ratios (IRRs), adjusting for age, sex, race/ethnicity, smoking prevalence, previous bacterial pneumonia, and chronic obstructive pulmonary disease.
  
  
  RESULTS
  The incidence rate of lung cancer in HIV-infected patients was 204 cases per 100,000 person-years [95% confidence interval (CI) 167-249] and among uninfected patients was 119 cases per 100,000 person-years (95% CI 110-129). The IRR of lung cancer associated with HIV infection remained significant after multivariable adjustment (IRR 1.7; 95% CI 1.5-1.9). Lung cancer stage at presentation did not differ between HIV-infected and uninfected patients.
  
  
  CONCLUSIONS
  In our cohort of demographically similar HIV-infected and uninfected patients, HIV infection was an independent risk factor for lung cancer after controlling for potential confounders including smoking. The similar stage distribution between the two groups indicated that surveillance bias was an unlikely explanation for this finding.
authors.affiliation: Mount Sinai School of Medicine, New York, New York, USA. keith.sigel@mssm.edu
authors.forename: Keith
authors.initials: K
authors.lastname: Sigel
authors.forename: Juan
authors.initials: J
authors.lastname: Wisnivesky
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.forename: Robert
authors.initials: R
authors.lastname: Dubrow
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Joseph
authors.initials: J
authors.lastname: Goulet
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Lesley S
authors.initials: LS
authors.lastname: Park
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans; D055815:Young Adult