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AIDS. 2015 Jun 19;29(10):1183-93. doi: 10.1097/QAD.0000000000000690.

Lung cancer incidence and survival among HIV-infected and uninfected women and men.

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aDepartments of Clinical Pharmacy & Medicine, University of California, San Francisco bDepartments of Obstetrics & Gynecology and Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA, and Department of Epidemiology, UCLA Fielding School of Public Health cCity of Hope National Medical Center, Duarte, and the Keck School of Medicine, University of Southern California, Los Angeles, California dDepartments of Medicine and Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania eDepartment of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland fDepartments of Medicine, Stroger Hospital and Rush University, Chicago, Illinois gDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.



To determine the lung cancer incidence and survival time among HIV-infected and uninfected women and men.


Two longitudinal studies of HIV infection in the United States.


Data from 2549 women in the Women's Interagency HIV Study (WIHS) and 4274 men in the Multicenter AIDS Cohort Study (MACS), all with a history of cigarette smoking, were analyzed. Lung cancer incidence rates and incidence rate ratios were calculated using Poisson regression analyses. Survival time was assessed using Kaplan-Meier and Cox proportional-hazard analyses.


Thirty-seven women and 23 men developed lung cancer (46 HIV-infected and 14 HIV-uninfected) during study follow-up. In multivariable analyses, the factors that were found to be independently associated with a higher lung cancer incidence rate ratios were older age, less education, 10 or more pack-years of smoking, and a prior diagnosis of AIDS pneumonia (vs. HIV-uninfected women). In an adjusted Cox model that allowed different hazard functions for each cohort, a history of injection drug use was associated with shorter survival, and a lung cancer diagnosis after 2001 was associated with longer survival. In an adjusted Cox model restricted to HIV-infected participants, nadir CD4 lymphocyte cell count less than 200 was associated with shorter survival time.


Our data suggest that pulmonary damage and inflammation associated with HIV infection may be causative for the increased risk of lung cancer. Encouraging and assisting younger HIV-infected smokers to quit and to sustain cessation of smoking is imperative to reduce the lung cancer burden in this population.

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