Meanwhile, the correlations between cancer and HIV — regarding risk and treatment effects — make communication between oncologists and infectious disease specialists more essential than ever.
“Working closely with oncologists in the spirit of trying to find a cure for HIV has created a renaissance of sorts of communication and collaboration between HIV providers and oncologists,” Saag said.
Mitsuyasu said he agreed.
“From a patient care standpoint, the communication lines have been improved — mostly because we are seeing more of these patients with HIV and cancer, but also because of the ‘Berlin patient’ case,” Mitsuyasu said. “The cure has caused the HIV community to get more interested in whether chemotherapy and/or transplant may have a bearing on eradication of HIV.” – by Jennifer Southall
Henrich T. Abstract WELBA05. Presented at: Conference on HIV Pathogenesis, Treatment and Prevention; June 30-July 3, 2013; Kuala Lumpur, Malaysia.
Mani D. Clin Lung Cancer. 2012;13:6-13.
Palacios J. Int J STD AIDS. 2013;doi:10.1177/0956462413499317.
Rubenstein PG. AIDS. 2014;28:453-465.
Shiels MS. J Natl Cancer Inst. 2012;104:1591-1598.
Sigel K. AIDS. 2012;26:1017-1025.
Torres H. Abstract #H-1255. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 10-13, 2013; Denver.
Yanik EL. Clin Infect Dis. 2013;doi:10.1093/cid/cit369.
For more information:
Alexandra M. Levine, MD, MACP, can be reached at City of Hope National Medical Center, 1500 E. Duarte Road, Needleman #213, Duarte, CA 91010; email: email@example.com.
Ronald T. Mitsuyasu, MD, can be reached at Center for Clinical AIDS Research and Education at UCLA, 1399 S. Roxbury Drive, Suite 100, Los Angeles, CA 90035; email: firstname.lastname@example.org.
Derek Raghavan, MD, PhD, FACP, FRACP, can be reached at Levine Cancer Institute, 1025 Morehead Medical Drive, Charlotte, NC 28204; email: email@example.com.
Erin Reid, MD, can be reached at Division of Hematology-Oncology, University of California, Moores UCSD Cancer Center, 3855 Health Sciences Drive, MC-0987, La Jolla, CA 92093; email: firstname.lastname@example.org.
Michael S. Saag, MD, can be reached at Center for AIDS Research at the University of Alabama at Birmingham, BBRB 256, 1720 2nd Ave. S, Birmingham, AL 35294-2107; email: email@example.com.
Paul A. Volberding, MD, can be reached at AIDS Research Institute, UCSF, 50 Beale St., 13th Floor — UCSF Box 0886, San Francisco, CA 94105; email: firstname.lastname@example.org.
Disclosure: Levine, Mitsuyasu, Raghavan, Reid, Saag and Volberding report no relevant financial disclosures.
Should lung cancer screening be mandatory for individuals with HIV?
National Lung Screening Trial-eligible individuals with HIV in otherwise good health may be considered for lung cancer screening.
Missak Haigentz Jr.
Given the survival benefit demonstrated in the National Lung Screening Trial (NLST), there is increasing agreement that lung cancer screening with low-dose CT should be offered to all persons who meet eligibility criteria for the trial (aged 55 to 74 years, with at least a 30-pack-year smoking history), which does not exclude those with HIV infection.
HIV-positive women and men in otherwise good health could, in theory, benefit from this technology. HIV-infected individuals have a several-fold increased risk for lung cancer relative to the general population, even after accounting for smoking. Thus, screening and early treatment of lung cancer could be of great importance in HIV-positive smokers in the United States, now that through the widespread use of combination antiretroviral therapy, longevity for HIV-infected persons increasingly approximates that in the country as a whole. Until proven otherwise, NLST-eligible populations should not be routinely excluded from potentially life-saving lung cancer detection and treatment.
However, there are a host of issues specific to HIV that will need to be addressed before low-dose CT is widely used to screen for lung cancer in all HIV-positive smokers. In particular, we must be concerned about a potentially higher rate for false-positive screening results — due either to infection from an immunocompromised state or chronic inflammation — that result in unnecessary psychological distress, as well as physical risk from diagnostic interventions. Ninety-one percent of the NLST included whites, whereas the HIV epidemic disproportionately affects minority populations, including immigrants from countries endemic for tuberculosis and fungal infections that may not be readily distinguished from lung cancer by low-dose CT. This is a matter that requires active research.
Conversely, there also is the question of whether the NLST screening criteria are appropriate or too conservative for this population. The published series of HIV-positive lung cancer cases to date have suggested a median age of lung cancer diagnosis in persons with HIV below the age of NLST eligibility (and frequently in the fourth decade of life), suggesting that most HIV-infected patients would not have had opportunity for early lung cancer detection had NLST age criteria been applied. Thus, the proper age and smoking intensity thresholds used to define the screening population will need to be separately addressed for HIV-infected populations.
In summary, NLST-eligible persons with HIV in otherwise good health may be considered for lung cancer screening, bearing in mind the above-mentioned concerns. Although it is premature to recommend low-dose CT in all HIV-positive individuals, the potential benefits are substantial and should be a more active research focus. Answering the important questions above regarding low-dose CT screening in persons with HIV is critical to addressing their high burden for lung cancer, currently responsible for 30% of cancer deaths and 10% of non–HIV-related deaths in this population.
Missak Haigentz Jr., MD, is an associate professor of clinical medicine at Albert Einstein College of Medicine and Montefiore Medical Center, and chair of the AIDS Malignancy Consortium’s Non-AIDS Defining Cancer Working Group. He can be reached at Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461; email: email@example.com. Disclosure: Haigentz reports no relevant financial disclosures.