NEW YORK—New veteran research is being touted as a way to better target lung-cancer prevention measures to high-risk groups.
The article, published in Lancet HIV, notes that HIV infection is independently associated with risk of lung cancer, but little information exists on the relationship between longitudinal measurements of immune function and lung-cancer risk in patients with the infectious disease.1
The study team was led by Mount Sinai researchers and included participation from the New Haven, CT, VAMC, the James J. Peters VAMC in Bronx, NY, the Atlanta VAMC, the Michael E. DeBakey VAMC in Houston, the Washington, DC, VAMC, the VA Los Angeles Healthcare System and the VA North Texas Health Care System in Dallas.
Researchers followed up on participants with HIV from the Veterans Aging Cohort Study for a minimum of three years between Jan. 1, 1998, and Dec. 31, 2012, using the cancer registry data to identify incident cases of lung cancer. With the index date for each patient being the later of the date HIV care began or Jan 1, 1998, models were adjusted for age, race or ethnicity, smoking, hepatitis C virus infection, alcohol use disorders, drug use disorders and history of chronic obstructive pulmonary disease and occupational lung disease.
Overall, 277 cases of incident lung cancer were identified in 21,666 participants with HIV. Results indicate that increased risk of lung cancer was associated with low CD4 cell count, low CD4/CD8 ratio, high HIV RNA concentration and more cumulative bacterial pneumonia episodes.
“In our large HIV cohort in the antiretroviral therapy era, we found evidence that dysfunctional immune activation and chronic inflammation contribute to the development of lung cancer in the setting of HIV infection,” study authors wrote. “These findings could be used to target lung-cancer prevention measures to high-risk groups.”
- Sigel K, Wisnivesky J, Crothers K, Gordon K, Brown ST, Rimland D,Rodriguez-Barradas MC, Gibert C, Goetz MB, Bedimo R, Park LS, Dubrow R. Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study. Lancet HIV. 2016 Dec 1. pii: S2352-3018(16)30215-6. doi: 10.1016/S2352-3018(16)30215-6. [Epub ahead of print] PubMed PMID: 27916584.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.