Lung Cancer in the Presence of Human Immunodeficiency Virus
Abstract:
Background: People living with human immunodeficiency virus (HIV) have a greater chance of developing malignancies. Success of antiretroviral therapy has led to non-HIV-associated cancers becoming the most common cause of death from acquired immune deficiency syndrome, and the most common of them in developed countries is the lung cancer.
Aim: To research nosological characteristics of lung cancer in the context of HIV infection, HIV-associated risk factors during antiretroviral therapy, and compare them with global trends.
Materials and Methods: Retrospectively analyzed the medical documentation of 98 patients with lung cancer and HIV-infection, who received specialized treatment in Saint Petersburg from 2008 to 2018.
Results: The researched population was dominated by patients of young (18–44 years old) and middle (45–59 years old) age groups, 45.9% and 42.9%, respectively, and 11.2% of elderly patients (60–71 years old), p <0.001. This is in accordance with the global data of earlier incidence of lung cancer in people living with HIV. Adenocarcinomas were the most common histological subtype of lung cancer, as in the general population (p <0.001). There was no statistical significance between high viral load and lung cancer, which can indicate the absence of a direct mechanism of HIV-carcinogenesis (90.8% of patients with low and medium viral load, p <0.001). Nevertheless, the prevalence of 4th stage of HIV infection among lung cancer patients (p <0.001) indicates a history of inflammatory diseases, including pulmonary diseases, as a result of induced immunosuppression due to CD8+-lymphocyte dysfunction and the formation of a tumor microenvironment. It can be a prognostic unfavorable factor in the occurrence of lung cancer in this group of patients, as well as of indirect mechanism of viral carcinogenesis. The presence of elderly patients (11.2%, the eldest patient of 71 years) indirectly indicates an increase of life expectancy among this category of patients in Russia.
Conclusion: The mechanisms behind increased risk of lung cancer among HIV-infected people remain largely unclear, and this can be the area for active research. HIV-infected patients with lung cancer are younger than HIV-negative patients, and have more advanced stages of cancer with a prevalence of adenocarcinoma. The lung cancer prognosis of survival in HIV-infected people is much worse than that in patients without HIV-infection, but it is not fully known whether this is due to a more aggressive course of the disease, disparities in treatment, treatment resistance, or a greater risk and toxicity of therapy
