Incidence and risk factors for lung cancer among women in the women's interagency HIV study (WIHS) and men in the multicenter AIDS cohort study (MACS)
© Hessol et al; licensee BioMed Central Ltd. 2012
Published: 19 April 2012
Studies have reported an increased incidence of lung cancer among people with HIV/AIDS compared to population estimates , but it is unclear whether this increase is due to HIV or to other lung cancer risk factors such as cigarette smoking. One study found that HIV-infected adults with preexisting lung disease displayed trends for increased lung cancer risk . Another study of people with AIDS reported that individuals with recurrent pneumonia were at significantly higher lung cancer risk than those without . Our aims were to determine the incidence and risk factors for lung cancer among participants in two longitudinal studies of HIV infection in United States women and men.
Data from 3763 women in the WIHS and 6972 men in the MACS were analyzed and incidence rates (IR) per 100,000 person-years and rate ratios (IRR) were calculated.
We identified 44 lung cancer cases (33 HIV+ and 11 HIV-), 25 in the WIHS and 19 in the MACS, all with a history of smoking cigarettes. Among current and former smokers, the IR was significantly higher in the WIHS than in the MACS (WIHS IR=110.4 and MACS IR=35.8, p<0.001) but did not differ by HIV status. In multivariable analyses of the MACS participants, >30 pack-years of smoking (IRR=10.2) and a prior AIDS diagnosis (IRR=4.9) were significantly associated with an increased lung cancer rate. In multivariable analyses of the WIHS participants, age >49 (IRR=2.9 for 50-59; IRR=10.1 for 60+), Black race (IRR=4.6), >9 pack-years of smoking (IRR=14.7 for 10-30 pack-years; IRR=20.7 for >30 pack-years), and prior AIDS pneumonia (IRR=7.5) were significantly associated with and increased rate of lung cancer while more recent year of cohort enrollment (IRR=0.4 for 2001-2002) was associated with a lower rate.
HIV infection was not associated with lung cancer in the WIHS and was no longer significant in the MACS after adjustment for a prior AIDS diagnosis. A prior diagnosis of AIDS pneumonia was a risk factor for lung cancer in the WIHS. Pack-years of smoking was a strong risk factors for lung cancer in both cohorts but was twice as strong in the WIHS. A better understanding of the effect of HIV on lung cancer is needed but cessation of smoking is an ideal goal for HIV-infected individuals.
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