HIV infection heralds worse outcomes in NSCLC

Oct 9 2013

By Joanna Lyford, Senior medwireNews Reporter

Infection with HIV is an indicator of poor prognosis in patients with non-small-cell lung cancer (NSCLC), analysis of epidemiologic data indicates.

The team behind the research believes that lung tumors may exhibit more aggressive behavior in the presence of HIV infection, although the reasons for this remain to be found.

Keith Sigel (Mount Sinai School of Medicine, New York, USA) and colleagues used the national Surveillance, Epidemiology and End Results (SEER) registry to investigate NSCLC prognosis in 267 patients with HIV infection and 1428 uninfected controls. All patients had been diagnosed with primary NSCLC between 1996 and 2007.

Patients with HIV infection were more likely to be African American and to reside in lower-income zip codes, less likely to be married, and had higher comorbidity scores than uninfected individuals. Histologic subtype and receipt of appropriate treatment were similar in the two groups.

During follow-up, 82% of patients with HIV infection died from any cause, compared with 66% of those without HIV. Median overall survival was significantly shorter in the HIV-positive than HIV-negative individuals, at 6 versus 20 months. Median 5-year survival was also significantly shorter, at 9% versus 23%.

Overall survival was worse in the presence of HIV infection irrespective of the stage of cancer and receipt or not of appropriate treatment, report the authors.

Indeed, HIV infection remained a significant independent predictor of all-cause mortality in both multivariate-adjusted regression analysis (hazard ratio=1.9) and in conditional probability analysis that accounted for competing risks for death (odds ratio=1.7).

Sigel et al say that their findings “suggest that the natural history of lung cancer may be more aggressive in patients with HIV,” although whether this is an effect of HIV infection per se or to HIV-related immunosuppressive therapy remains unclear.

“HIV management in HIV-infected patients with NSCLC may affect their oncologic course,” they note; another possibility is that HIV-infected patients are less tolerant of chemotherapy or have a different frequency of specific oncogenic mutations that impact response to treatment.

The authors conclude: “Further research is needed to evaluate the effect of specific factors associated with HIV infection, such as immunosuppression and cART [combination antiretroviral therapy] use, on lung cancer prognosis.”

The study is published in the British Journal of Cancer.

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