Delayed diagnosis and elevated mortality in an urban population with HIV and lung cancer: Implications for patient care

Malcolm V. Brock, Craig M. Hooker, Eric A. Engels, Richard D. Moore, Maura L. Gillison, Anthony J. Alberg, Jeanne C. Keruly, Stephen C. Yang, Richard F. Heitmiller, Stephen B. Baylin, James G. Herman, Julie R. Brahmer

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Lung cancer is more common in HIV-infected patients than in the general population. We examined how effectively lung cancer was being diagnosed in our HIV-infected patients. METHODS: Retrospective study assessing clinical diagnosis of lung cancer in HIV-infected patients at Johns Hopkins Hospital between 1986 and 2004. RESULTS: Ninety-two patients were identified. Compared to HIV-indeterminate patients (n = 4973), HIV-infected individuals were younger with more advanced cancer. CD4 counts and HIV-1 RNA levels indicated preserved immune function. Mortality was higher in HIV-infected patients, with 92% dying of lung cancer (hazard ratio, 1.57; 95% confidence interval, 1.25-1.96), compared to HIV-uninfected patients. Advanced stage and black race were associated with worse survival. After adjustment for these factors, HIV infection was not associated with increased mortality (hazard ratio, 1.04; 95% confidence interval, 0.83-1.32). Of 32 patients followed in our HIV clinic, 60% of chest radiographs had no evidence of neoplasm within 1 year of diagnosis compared to only 1 (4%) of 28 chest computed tomography scans. Nonspecific infiltrates were observed in 9 patients in the same area that cancer was subsequently diagnosed. CONCLUSIONS: HIV-infected lung cancer patients have shortened survival mainly due to advanced stage. Low clinical suspicion and overreliance on chest radiographs hindered earlier detection. Aggressive follow-up of nonspecific pulmonary infiltrates in these patients is warranted.

Original languageEnglish (US)
Pages (from-to)47-55
Number of pages9
JournalJournal of acquired immune deficiency syndromes
Volume43
Issue number1
DOIs
StatePublished - Sep 2006

Keywords

  • AIDS
  • HIV
  • Lung cancers
  • Mortality
  • Surveillance
  • Survival

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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