HIV as an Independent Risk Factor for Incident Lung Cancer

• Type of Material: Article
• Authors: Keith Sigel, Mount Sinai School of Medicine; Juan Wisnivesky, Mount Sinai School of Medicine; Kirsha Gordon, Yale University; Robert Dubrow, Yale University; Amy Justice, Yale University; Sheldon T. Brown, Mount Sinai School of Medicine; Joseph Goulet, Yale University; Adeel A. Butt, University of Pittsburgh; Stephen Crystal, Rutgers State University; David Rimland, Emory University; Maria Rodriguez-Barradas, Michael E. DeBakey Veterans Affairs (VA) Medical Center; Cynthia Gibert, George Washington University; Lesley Park, Yale University; Kristina Crothers, University of Washington
• Language: English
• Date: 2012-05-15
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Lippincott Williams & Wilkins.; © 2012 Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0b013e328352d1ad
• Title of Journal or Parent Work: AIDS
• ISSN: 0269-9370
• Volume: 26
• Issue: 8
• Start Page: 1017
• End Page: 1025
• Grant/Funding Information: This study was supported by the National Center for Research Resources (KL2RR029885 to K.S.), National Institute on Alcohol and Alcohol Abuse (3U01 AA 13566), National Institute of Aging (K23 AG00826), Robert Wood Johnson Generalist Faculty Scholar Award, an interagency agreement between National Institute on Aging, National Institute of Mental Health and the Veterans Health Administration, and the Veterans Health Administration Office of Research and Development and Public Health Strategic Healthcare Group (to A.C.J.), and National Heart, Lung, and Blood Institute (NIH/NHLBI R01 HL090342 to K.C.).
• Keywords: IMMUNODEFICIENCY; UNITED-STATES; lung cancer; Science & Technology; INJECTION-DRUG USERS; INFECTED PATIENTS; ACTIVE ANTIRETROVIRAL THERAPY; MORTALITY; WOMENS INTERAGENCY HIV; incidence; smoking; AIDS; non-AIDS-defining malignancy; CIGARETTE-SMOKING; HIV; Immunology; Life Sciences & Biomedicine; Infectious Diseases; DEFINING MALIGNANCIES; Virology; immunosuppression
• Research Categories: Health Sciences, Immunology; Biology, Virology

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. Design: 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. Conclusion: 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.