Bronchogenic carcinoma in patients seropositive for human immunodeficiency virus

As the HIV epidemic continues and the patients are closely followed throughout the course of the illness from HIV seropositivity to depressed total CD4 counts, the natural history of lung cancer in this population is evolving. HIV-infected patients with lung cancer are in general younger men with significant smoking histories. Adenocarcinoma is the predominant cell type. There has been no correlation between stage of lung cancer and CD4 counts. The lung cancer stage at presentation has also not affected prognosis (no survivors beyond 1 year from diagnosis). While HIV seropositivity has not yet been identified as a risk factor for bronchogenic carcinoma, the current literature suggests that lung neoplasms behave in an aggressive manner in HIV-positive patients. We present two cases to illustrate the value of transbronchial biopsy which should be performed in all patients with masses, nodules, or focal lesions that persist despite appropriate therapy for opportunistic organisms in HIV-positive patients.