title: HIV-associated lung cancer: survival in an unselected cohort.
abstract: BACKGROUND
  Lung cancer is one of the most common non-AIDS-defining malignancies in HIV-infected patients. However, data on clinical outcome and prognostic factors are scarce.
  
  
  METHODS
  This was a national German multicentre, retrospective cohort analysis of all cases of lung cancer seen in HIV-infected individuals from 2000 through 2010. Survival was analyzed with respect to the use of antiretroviral therapy (ART), specific lung cancer therapies, and other potential prognostic factors.
  
  
  RESULTS
  A total of 72 patients (mean age 55.5 y, CD4 T-cells 383/μl) were evaluated in this analysis. At time of lung cancer diagnosis, 86% were on ART. Of these, 79% had undetectable HIV-1 RNA (< 50 copies/ml) for a mean duration of 4.0 y. All but 1 patient were current or former heavy smokers (mean 42 package y). The median estimated overall survival was 1.08 y, with a 2-y overall survival of 24%. The prognosis did not improve during the observation time. A limited lung cancer stage of I-IIIA was associated with better overall survival when compared with the advanced stages IIIb/IV (p = 0.0003). Other factors predictive of improved overall survival were better performance status, CD4 T-cells > 200/μl, and a non-intravenous drug use transmission risk for HIV.
  
  
  CONCLUSIONS
  Currently, most cases of lung cancer occur in the setting of limited immune deficiency and a long-lasting viral suppression. As in HIV-negative cases, the clinical stage of lung cancer is highly predictive of survival, and long-term overall survival can only be achieved at the limited stages. The still high mortality underscores the importance of smoking cessation strategies in HIV-infected patients.
authors.affiliation: From the Infektionsmedizinisches Centrum Stadtmitte , Hamburg.
authors.forename: Christian
authors.initials: C
authors.lastname: Hoffmann
authors.forename: Fabienne
authors.initials: F
authors.lastname: Kohrs
authors.forename: Michael
authors.initials: M
authors.lastname: Sabranski
authors.forename: Eva
authors.initials: E
authors.lastname: Wolf
authors.forename: Hans
authors.initials: H
authors.lastname: Jaeger
authors.forename: Christoph
authors.initials: C
authors.lastname: Wyen
authors.forename: Jan
authors.initials: J
authors.lastname: Siehl
authors.forename: Axel
authors.initials: A
authors.lastname: Baumgarten
authors.forename: Manfred
authors.initials: M
authors.lastname: Hensel
authors.forename: Arne
authors.initials: A
authors.lastname: Jessen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaaf
authors.forename: Martin
authors.initials: M
authors.lastname: Vogel
authors.forename: Johannes
authors.initials: J
authors.lastname: Bogner
authors.forename: Heinz-August
authors.initials: HA
authors.lastname: Horst
authors.forename: Christoph
authors.initials: C
authors.lastname: Stephan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis