Increased Mortality Among Lung Cancer Patients with HIV
APRIL 24, 2018
Elizabeth Kukielka, PharmD
Yue-Hua WangMany studies have demonstrated that patients living with HIV are at a higher risk of a number of different types of malignancies, including lung cancer. Research has also shown that cancer patients living with HIV have a poorer prognosis than cancer patients who do not have HIV.
Drawing on these studies, researchers have begun to investigate whether lung cancer patients with HIV have a poorer prognosis and potentially increased mortality compared with lung cancer patients who do not have HIV, but the published findings up to this point in time have been inconsistent. Doctor Yue-Hua Wang, of Jinhua People’s Hospital in China, and her colleague, Doctor Xiang-Di Shen, of Hangzhou Medical College in China, performed a systematic review and meta-analysis to further clarify the relationship between HIV and lung cancer mortality. Their study was the first of this kind on this specific patient population.
Wang and Shen performed a systematic review of literature to identify relevant studies. Ultimately, they identified 12 studies to be included in their meta-analysis. Included studies were all cohort studies that had investigated the link between HIV infection and mortality among patients with lung cancer.
All but 1 of the included studies took place in North America (the other took place in Europe) with a widely varied number of patients that ranged from 29 to 328,924 and a follow-up period that ranged from 1 to 5 years. Three studies specifically looked at patients with non-small cell lung cancer (NSCLC), while the others did not stratify their results based on the histological type of lung cancer.
The meta-analysis revealed a significant association between lung cancer mortality and HIV infection, and this was further supported by sensitivity analyses. Wang and Shen admit that the biological mechanisms behind their findings are not yet clear.
“HIV infection is associated with poor immune regulatory function, which may make the immune system in lung cancer patients lose the ability to control the proliferation or metastasis of tumor cells. It has also been suggested that the respiratory system is particularly susceptible to the damages caused by HIV-related immunosuppression,” they hypothesized.
Wang and Shen identified several strengths of their study, including their large sample size and the fact that their sensitivity analyses supported the findings of their meta-analysis.
In terms of weaknesses, only a few studies included in the meta-analysis looked specifically at patients with NSCLC, and none of the studies examined the sub-group of patients with small cell lung cancer (SCLC). In addition, the study authors suggested that future prospective studies were needed due to the fact that several of the studies included in the meta-analysis were retrospective in nature.
“This study provides strong evidence for the elevated risk of mortality among lung cancer patients with HIV infection. Future studies are recommended to assess the prognostic role of HIV infection in SCLC patients or lung cancer patients from Asian or African populations,” Wang and Shen concluded.
The study, “Human immunodeficiency virus infection and mortality risk among lung cancer patients,” was published this month in Medicine.