Delayed Diagnosis and Elevated Mortality in an Urban Population With HIV and Lung Cancer: Implications for Patient Care

Lung cancer is more common in HIV patients than in the general population, observed the authors. They conducted a retrospective analysis of lung cancer diagnoses in HIV patients at Johns Hopkins Hospital between 1986 and 2004 to determine how effectively the cancer was being diagnosed in these patients.

In comparison to 4,973 lung cancer patients of indeterminate HIV status, the 92 HIV patients diagnosed with lung cancer were younger and at a more advanced stage of cancer. HIV patients' CD4 counts and viral RNA levels indicated preserved immune function.

Lung cancer mortality was higher among HIV-infected patients (92 percent [hazard ratio [HR], 1.57; 95 percent confidence interval [CI], 1.25-1.96]) than among HIV-negative patients. After adjusting for advanced cancer stage and black race, which were associated with worse survival, HIV infection was not associated with increased mortality (HR, 1.04, 95 percent CI, 0.83-1.32).

Of 32 patients followed at the HIV clinic, 60 percent showed no chest radiograph evidence of neoplasm within one year of lung cancer diagnosis. Of 28 chest computed tomography scans conducted, 4 percent showed no such evidence. In nine patients, nonspecific infiltrates were observed in the same area where cancer was later diagnosed.

"HIV-infected lung cancer patients have shortened survival mainly due to advanced stage," concluded the authors. "Low clinical suspicion and overreliance on chest radiographs hindered earlier detection. Aggressive follow-up of nonspecific pulmonary infiltrates in these patients is warranted."

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