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Higher CD4 Count at Lung Cancer Diagnosis Predicts Survival
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
A CD4 count above 200 at diagnosis of non-small-cell lung cancer (NSCLC) and antiretroviral therapy favored survival in a French cohort of people with HIV [1]. NSCLC leads non-AIDS cancers as a cause of death in people with HIV, and the incidence of NSCLC is higher in HIV-infected people than in the general population in analyses adjusted for age, gender, and smoking status.
This study involved 52 adults diagnosed with NSCLC in seven French public hospitals between 1996 and 2008. Forty-two of these people (81%) were men, and 37 (71%) died during a median follow-up of 12 months (range 0.6 to 83). Median age stood at 48 years (range 32 to 77), 51 people (98%) smoked, and 18 (35%) had HCV coinfection. Thirty-four people (65%) has a performance status below 2 at NSCLC diagnosis. Forty-two people (81%) received chemotherapy, and 47 (90%) were taking combination antiretroviral therapy.
Median CD4 count stood at 300 at NSCLC diagnosis and ranged from 25 to 1551. Thirty-eight people (73%) had a CD4 count above 200 at cancer diagnosis, and 13 (25%) had a nadir CD4 count above 200. Twenty-nine people (56%) had a viral load below 200 copies at NSCLC diagnosis, and 16 people (31%) had AIDS. Only 7 people (13%) had stage 1 or 2 cancer. Adenocarcinoma was the most common histologic type (71%), followed by epidermoid carcinoma (27%) and bronchoalveolar adenocarcinoma (2%).
The investigators built a statistical model that considered gender, age, CD4 count at NSCLC diagnosis, nadir CD4 count, history of AIDS, viral load at cancer diagnosis, adenocarcinoma (versus other histologic types), performance status at cancer diagnosis, localized (stage 1 or 2) cancer at diagnosis, HCV coinfection, treatment with chemotherapy, and antiretroviral therapy. The multivariate model included all prognostic factors with a P value below 0.2 in univariate analysis.
A CD4 count at or above 200 at cancer diagnosis lowered the risk of death 70% (hazard ratio [HR] 0.30, 95% confidence interval 0.10 to 0.91, P = 0.033). Receiving antiretroviral therapy cut the death risk 74% (HR 0.26, 95% CI 0.09 to 0.74, P = 0.11). And a performance status below 2 lowered the death risk 70% (HR 0.30, 95% CI 0.15 to 0.63, P = 0.001).
Earlier work correlated performance status with survival in HIV-infected people with NSCLC [2], but the investigators believe their study is the first to make this correlation for a higher CD4 count at cancer diagnosis. They called for further study to determine whether the link between antiretroviral therapy and survival reflects immune-mediated control of the tumor. The researchers suggested that failure to find an independent association between tumor stage or chemotherapy and survival may be explained by insufficient statistical power in their small study. But the lack of association between chemotherapy and survival "could also reflect, as in the non-HIV-infected population with advanced NSCLC, a moderate survival benefit engendered by chemotherapy."
References
1. Makinson A, Tenon JC, Eymark-Duvernay S, et al. T CD4 lymphocyte level at diagnosis of non small cell lung cancer is associated with overall survival in HIV-infected patients. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract TUPE0160.
2. Lavole A, Chouaid C, Baudrin L, Wislez M, et al. Effect of highly active antiretroviral therapy on survival of HIV infected patients with non-small-cell lung cancer. Lung Cancer. 2009;65:345-350.
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