The incidence of lung cancer among individuals infected with the human immunodeficiency virus (HIV) is elevated compared to that among the general population. This study examines the prevalence of HIV and its impact on outcomes among Medicare beneficiaries who are 65 years of age or older and were diagnosed with nonsmall cell lung cancer (NSCLC) between 1997 and 2008. Prevalence of HIV was estimated using the Poisson point estimate and its 95% confidence interval. Relative risks for potential risk factors were estimated using the log-binomial model. A total of 111,219 Medicare beneficiaries met the study criteria. The prevalence of HIV was 156.4 per 100,000 (95% CI: 140.8 to 173.8) and has increased with time. Stage at NSCLC diagnosis did not vary by HIV status. Mortality rates due to all causes were 44%, 76%, and 88% for patients with stage I/II, III, and IV NSCLC, respectively. Across stages of disease, there was no difference between those who were HIV-infected and those who were not with respect to overall mortality. HIV patients, however, were more likely to die of causes other than lung cancer than their immunocompetent counterparts. 1. Introduction With the widespread use of highly active antiretroviral therapy (HAART), the incidence of non-AIDS defining malignancies among HIV-infected persons has increased [1, 2]. The most frequently reported non-AIDS defining cancer among HIV-infected individuals is lung cancer. The incidence of lung cancer among individuals infected with human immunodeficiency virus (HIV) is elevated compared to the incidence in the general population [1–8] and has increased with time [2]. HIV-infected individuals are at least twice as likely as those who are not infected with HIV to be diagnosed with lung cancer [1, 6, 8]. The risk of lung cancer among HIV-infected patients is inversely related to CD4 count, a measure of immune function [9], and it has been suggested that use of antiretroviral viral therapy may reduce the risk of lung cancer [10]. At the time of lung cancer diagnosis, HIV-infected patients were younger than those who were not shown to have HIV [11, 12]. Survival of HIV-infected lung cancer patients was similar to that of their immunocompetent counterparts when the majority of HIV-infected patients were on HAART [11, 13]. Positive prognostic factors for survival among HIV-infected lung cancer cases are the use of HAART [14] and CD4 counts [15]. The impact of HIV infection on the population of lung cancer patients is unclear. This study uses data from the SEER-Medicare database to determine the prevalence of
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