AIDS-Related Bronchogenic Carcinoma. Fact or Fiction: Discussion

Patients infected with HIV and AIDS are at increased risk of OIs. As more efficacious means of therapy and prevention have developed, these previously life-threatening OIs have become less enigmatic. HIV-AIDS patients now live longer with delays in progression to symptomatic disease. The longevity of these patients is now complicated by a new challenge, HIV-AIDS-related neoplasms.
The development of malignant neoplasms in im-munodeficient states has been well documented in various primary immunodeficiency diseases (eg, Wiskott-Aldrich syndrome, ataxia telangiectasia, X-linked Bruton’s type agammaglobulinemia, X-linked lymphoproliferative syndrome), and secondary immunodeficiency states induced by immunosuppressive drugs (eg, organ transplantation, cytotoxic cancer chemotherapy).
As many as 36% of all HIV-AIDS patients will develop a malignant neoplasm at some point during the course of their illness. To date, 95% of these neoplasms have consisted of Kaposi’s sarcoma and/or B-cell lymphoma. It is expected that the development of malignant disease will become even more prominent as these infected individuals live longer. This has already been realized to some extent with increased reports of squamous cell carcinoma of the oral cavity, cloacogenic carcinoma of the anorectum, and basal cell carcinoma of the skin in the HIV-AIDS patient population. Recently, invasive cervical carcinoma has been added to the list of AIDS-defining illnesses.
Irwin et al first reported a case of adenosqua-mous cell carcinoma of the lung in a 35-year-old male homosexual with AIDS. Subsequently, Moser et al and Nusbaum separately reported a case of oat-cell carcinoma and metastatic small cell carcinoma, respectively. Additional sporadic case reports followed. Many thought these cases simply represented coincidental carcinomas. Other reports did not help validate an association between these two diseases. Biggar et al examined the cancers seen among New York men at risk of AIDS. During the study period of 1973 to 1985, they found an increase in both Kaposi’s sarcoma and non-Hodgkin’s lymphoma, but observed no increase in other neoplasms, including lung cancer. Between December 1986 and December 1988, the Italian Cooperative Group on AIDS-Related Tumors (GICAT) documented 49 HIV-related tumors other than malignant lymphomas and Kaposi’s sarcoma. This study included eight primary bronchogenic carcinomas. However, they reported this was not in excess of the rate expected for the general population The largest series reported outside the United States was again by the GICAT. In 1993, the GICAT reported 19 cases of lung cancer in the HIV-AIDS patient population, but again this incidence was not identified as statistically increased. Chan et al reviewed the tumor registry at Bellvue Hospital during a designated pre-AIDS period (1976 to 1979) and an AIDS period (1987 to 1990). They concluded there was no increased risk of lung cancer and the relationship between HIV-AIDS was probably coincidental.

Category: Bronchogenic Carcinoma

Tags: acquired immunodeficiency syndrome, cohort; epidemiology, human immunodeficiency virus, neoplasm, primary lung carcinoma