Division of Internal Medicine, Providence Sacred Heart Medical Center, Spokane, WA 98111, USA.
Clin Lung Cancer. 2012 Jan;13(1):6-13. doi: 10.1016/j.cllc.2011.05.005. Epub 2011 Jul 29.
Lung cancer is the most prevalent non-AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.
在高效抗逆转录病毒治疗时代，肺癌是最常见的非艾滋病定义性恶性肿瘤。吸烟在 HIV 相关肺癌的发展中起重要作用，但即使在调整吸烟强度和持续时间后，HIV 感染者的癌症风险仍比普通人群高 2 至 4 倍。与未感染 HIV 的人相比，HIV 感染者（平均年龄 46 岁）通常更早被诊断出肺癌（mean age, 46 years）。腺癌是最常见的组织学亚型，大多数患者被诊断为局部晚期或转移性癌。由于 HIV 感染者中肺部感染很常见，因此临床医生可能不会怀疑该年轻患者群体患有肺癌。对于早期疾病，手术切除仍然是首选治疗方法。尽管对于没有手术选择的 HIV 感染者，使用放疗和化疗的经验越来越多，但由于该人群经常被排除在癌症试验之外，因此仍需要前瞻性研究。必须将基于证据的戒烟治疗方案纳入 HIV 阳性吸烟者的常规护理中，这些方案在普通人群中已被证实有效。
