AIDS-Related Bronchogenic Carcinoma. Fact or Fiction: Results

AIDS-Related Bronchogenic Carcinoma.Fact or Fiction: ResultsTable 2 demonstrates the demographic variables observed within the HIV-AIDS cohort and the age at which both the diagnosis of HIV-AIDS and of lung neoplasm was established. Thirty-five of the 36 primary lung carcinoma patients were male (97.2%). Twenty-four (66.7%) of the patients were white and 10 patients (27.8%) were African-Americans. The median age at time of HIV-AIDS diagnosis among the primary lung cancer patients was 48 years. The median age at time of diagnosis of lung neoplasm was 49 years.
Homosexual/bisexual and/or IV drug user male subjects accounted for 80% of the HIV transmission among the 36 lung neoplasm patients. Table 3 summarizes the mode of HIV transmission in our cohort.
The most common concomitant opportunistic infections (OIs) in the HIV-AIDS cohort were also reviewed to determine any possible association with the development of lung carcinoma (Table 4). No statistically significant differences were demonstrated between the 36 lung neoplasm patients and the entire cohort. Pneumocystis carinii pneumonia (PCP) was the most frequently noted OI in these 36 patients.
A total of 76 neoplasms were observed in the HIV-AIDS cohort and only 5.6 cases were expected. The observed/expected ratio or SIR for all lung neoplasms compared to the US population was 13.6 (10.8 to 17.1, 95% confidence interval). A total of 36 cases of primary bronchogenic carcinoma were observed in the HIV-AIDS cohort, where 5.6 cases were expected, giving an SIR of 6.5 (4.5 to 8.9, 95% confidence interval).
Table 5 summarizes the distribution of histologic types of lung cancer observed in the HIV-AIDS cohort versus that seen in the US population. Sarcomas comprised the largest percentage of cancers in the HIV-AIDS cohort, 52.6%, as compared to 0.1% in the US population. Adenocarcinomas comprised the largest percentage of the total cases of primary bronchogenic carcinoma in both groups. Squamous cell carcinoma ranked second among identifiable cell types (9.2%).
Table 2—Distribution of Demographic Variables Within the HIV/AIDS Cohort, Texas, 1990 to 1995

Entire Cohort (n=26,181) All Lung Neoplasms (n—76) Primary Lung Cancer Cases (n=36)
Variable Frequency % Frequency % Frequency %
SexMale 23,518 89.8 73 96.1 35 97.2
Female 2,663 10.2 3 3.9 1 2.8
Race/Ethnicity
White 14,122 53.9 50 65.8 24 66.7
African-American 7,134 27.2 14 18.4 10 27.8
Hispanic 4,794 18.3 12 15.8 2 5.6
Asian 81 0.3 0 0.0 0 0.0
Native American 42 0.2 0 0.0 0 0.0
Unknown 8 <0.01 0 0.0 0 0.0
Age at HIV/AIDS diagnosis, yr
0-19 385 1.5 0 0.0 0 0.0
20-39 18,252 69.7 39 51.3 11 30.6
40-59 7,026 26.8 29 38.1 19 52.8
60+ 518 2.0 8 10.5 6 16.7
Age at lung neoplasm diagnosis, yr
0-19 0 0.0 0 0.0
20-39 36 47.4 10 27.8
40-59 30 39.5 18 50.0
60 + 10 13.1 8 22.2

Table 3—Mode of HIV Transmission, Texas, 1990 to 1995

Mode Entire Cohort (n=26,181) All Lung Neoplasms (n=76) Primary Lung Cancer Cases (n=36)
Frequency % Frequency % Frequency %
Homosexual/bisexual male 15,762 60.2 50 65.8 17 47.2
IVDU 3,853 14.7 12 15.8 9 25.0
HomosexualIVDU 2,272 8.7 4 5.3 3 8.3
Hemophiliac (adult) 142 0.5 1 1.3 1 2.8
Heterosexual contact 1,748 6.7 3 3.9 2 5.6
T ransfusion/transplant 268 1.0 1 1.3 1 2.8
Confirmed other 2 <0.1 0 0.0 0 0.0
Unspecified risk 1,909 7.3 5 6.6 3 8.3
Pediatric 225 0.9 0 0.0 0 0.0

Table 4—Distribution of OIs, Texas, 1990 to 1995

Entire Cohort (n=26,181) All Lung Neoplasms (n=76) Primary Lung Cancer Cases (n=36)
Infection Frequency % Frequency % Frequency %
Cytomegalovirus 1,362 5.2 7 9.2 3 8.3
Mycobacterium avium complex 1,732 6.6 8 10.5 1 2.8
PCP 7,395 28.3 28 36.9 10 27.7
M tuberculosis* 602 2.3 0 0.0 0 0.0
Pulmonary TB 1,129 4.4 8 10.5 6 16.6

Table 5—Invasive Lung Cancer Frequency by Histologic Subgroups, SEER9 1983 to 1987; Texas, 1990 to 1995

% of Total
US Texas HIV-AIDS
Histologic Type Population Cohort
Adenocarcinomas 31.5 11.8
Squamous cell carcinomas 29.4 9.2
Other specified carcinomas 19.1 2.6
Unspecified carcinomas 17.8 6.5
Sarcoma and other soft-tissue tumors 0.1 52.6
Other specified types 0.1 1.3
Unspecified 1.9 11.8

Category: Bronchogenic Carcinoma

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