Interactions between
combination antiretroviral therapy (CART) and
lung cancer treatment are emerging clinical concerns. Among the reasons for that, one can observe the longer survival of human immunodeficiency virus (HIV)-infected patients since introduction of CART and the epidemiologic rising of
lung cancer, mainly
adenocarcinomas, in this population. In addition, the higher relative risk of
lung cancer in HIV-infected patients compared with general population has been recently demonstrated. Patients' demography and disease characteristics differ from the general
lung cancer population, although most cases occur in patients with a smoking history: HIV-infected subjects are generally younger and diagnosis frequently made at locally advanced or metastatic stages. The choice of cytotoxic
chemotherapy and antiretroviral
therapy is essential in the context of
lung cancer (1) to minimize potential interactions and life-threatening toxicities particularly through
cytochrome P450 interaction, (2) to implement adequate prevention of foreseeable toxicity, and (3) to fully reinforce
antineoplastic and antiretroviral efficacy. Pharmacokinetics data and clinical cases pinpoint to potential life-threatening interactions between
protease inhibitors/
ritonavir and
taxanes,
vinca alkaloids, as well as the anilinoquinazolines
erlotinib and
gefitinib and
irinotecan. Optimal choice of
chemotherapy and CART in HIV-infected patients with
lung cancer is an individualized multidisciplinary decision, involving clinical and antiretroviral history, and predicting potential adverse events and interactions.