Although initial reports did not suggest that HAART had

a huge impact, with average survival still only 4 months, later studies have found a median survival of up to 9 months in advanced stage disease although this is still less than that reported in clinical trials from the general population [13,17]. This poorer outcome may just reflect more advanced disease and, when this taken in account, the true prognosis may well be similar in HIV-positive and -negative populations [13]. It is clear that there is a delay in the diagnosis of HIV-positive lung cancer patients and this may in part be click here due to the wide differential diagnosis of an HIV patient with a mass in the lungs [14]. As HIV patients with NSCLC present at a younger age than their HIV-negative counterparts, a mass on chest X-ray should raise the suspicion of NSCLC. It is recommend that in addition to a tissue diagnosis, patients should have a CT of the chest and abdomen (including adrenals), and bone scan. If an individual is still potentially operable then a mediastinoscopy should be performed. In view of the possible decreased specificity and lack of data regarding FDG-PET in HIV-positive lung cancer, PET results should be interpreted with caution. Patients should not necessarily be deemed inoperable on the evidence of FDG-PET alone. The results of FDG-PET should be considered in conjunction with HIV status (HIV history,

opportunistic infections, Atazanavir viral load and CD4 cell counts). Cranial imaging is indicated in patients Ivacaftor manufacturer eligible for

loco-regional treatment, or in the presence of clinical symptoms. Those with operative disease should be offered curative surgery, once staging investigations are complete; however, studies suggest that a small minority of HIV-positive lung cancer patients are actually offered this [14]. This is due to a combination of patients presenting with advanced disease and comorbidity. Although 30-day post-operative mortality is comparable to that in the general population, there is an increase in complications and recurrence, whilst overall survival is reduced [18]. The latter are most pronounced if the CD4 cell count is below 200 cells/μL. There are no data regarding the use of adjuvant chemotherapy in HIV-related lung cancer, therefore these patients should follow the HIV-negative lung cancer guidelines. Chemotherapy should consist of standard regimens and doses. HAART should continue throughout treatment. Follow-up should be as with HIV-negative patients. There are no data specifically addressing this issue. Patients with locally advanced disease should be offered chemoradiation according to HIV-negative guidelines. It is noteworthy that grade 3/4 treatment-associated toxicities have been reported in 60% of HIV-positive lung cancer patients, whilst chemoradiotherapy is associated with profound immunosuppression in other HIV-positive tumours [19,20].