Characterization of the clinical epidemiology of lung cancer and relationship to HIV-1 infection in Uganda and Tanzania

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ABSTRACT – Project 1 The innovation of our research proposal focuses on three main areas: 1) primary prevention; 2) screening; and 3) personalized medicine. Currently, several studies in the US and Africa have demonstrated that HIV-1 infection increases the risk of lifetime cancer risk, particularly lung cancer. The etiology of lung cancer among HIV-1 infected individuals is unknown, but of great importance given the number of individuals who live infected with HIV-1. Here we will investigate potential risk factors for lung cancer such as geospatial residence, indoor and outdoor air quality, and smoking behavior to better understand the underlying risk factors. This general knowledge will serve to develop primary prevention programs designed to reduce adverse exposures thus lowering the onset of lung cancer disease. Beyond primary prevention, our proposal will assess clinical features associated with lung cancer risk and progression among those infected by HIV-1. This will provide the opportunity to develop screening programs based on HIV-1 infection status thus detecting disease at an earlier phase and decreasing the overall mortality. For example, TB may present as lung nodules during chest x-rays and patients who actually have lung cancer have a delay in the diagnosis of lung cancer and life-saving treatments. Understanding this relationship will better enable physicians and health providers to provide comprehensive screening. Lastly, our proposal will expand the concept of personalized medicine by providing a descriptive analysis of somatic genomic mutations among lung cancer cases infected with HIV-1. This will provide the basis to examine for differences and provide optimal care under current guidelines.