Cancer incidence in people with HIV in Italy: Comparison of the ICONA COHORT with general population data.

in International journal of cancer by Pierluca Piselli, Alessandro Tavelli, Claudia Cimaglia, Camilla Muccini, Alessandra Bandera, Giulia C Marchetti, Carlo Torti, Valentina Mazzotta, Luca Pipitò, Alessandro Caioli, Enrico Girardi, Andrea Antinori, Diego Serraino, Antonella d'Arminio Monforte, Antonella Cingolani,

TLDR

  • The study found that HIV-positive individuals have a 1.6-fold higher risk for all cancers compared to the general population, with increased risks for virus-related cancers.

Abstract

The cancer risk of people with HIV (PWH) enrolled in the Italian COhort of Naives to Antiretrovirals (ICONA) with HIV diagnosis occurred between 01/1997 and 12/2023 has been compared to that of the corresponding general population of Italy. Incident cancers were grouped according to their association with viral infections. Standardized incidence ratios (SIRs) were estimated as the ratio between the observed number of cancers among PWH and the expected ones among the general population. Competing risks cumulative incidence curves and Gray's test were used to compare incidence between groups (gender and CD4+ T-cells values at diagnosis) with death as a competing risk. Overall, 17,298 PWH (79.1% males) contributing to 133,851 person-years of follow-up were included; 763 (4.4%) developed > = 1 incident cancers, the most frequent cancers being KS (N = 204), NHL (N = 127) and lung-trachea-bronchus (N = 66). PWH were at 1.6-times higher risk for all cancers compared to the general population (SIR = 1.6, 95% CI: 1.5-1.8), with significantly increased SIR for almost all virus-related cancers, including KS (SIR = 145), NHL (SIR = 5.8), ICC (SIR = 6.0), anal cancer (SIR = 21.0) and Hodgkin lymphoma (SIR = 10.0). Apart from lung cancer risk (SIR = 1.3), none of the non-virus-related cancers turned out to be more frequent among PWH. PWH with CD4 + <200 cells/mmat cART initiation showed the highest cancer incidence, 5% after 5 years, versus 3% for CD4+ 200-349 and 2% for CD4+ >350 (p < .001). These findings underscore the need to continue prevention efforts in PWH, including behavioral risk reduction, early cART initiation, screening, and vaccination.

Overview

  • The study compared the cancer risk of HIV-positive individuals enrolled in the Italian COhort of Naives to Antiretrovirals (ICONA) with the general population of Italy.
  • The study analyzed incident cancers according to their association with viral infections and estimated standardized incidence ratios (SIRs) relative to the general population.
  • The primary objective was to investigate the cancer risk and identify factors associated with increased cancer incidence in HIV-positive individuals.

Comparative Analysis & Findings

  • HIV-positive individuals were found to be at a 1.6-fold higher risk for all cancers compared to the general population, with significantly increased risks for virus-related cancers.
  • Cancer incidence was highest for Kaposi's sarcoma, non-Hodgkin lymphoma, and lung-trachea-bronchus cancers, with SIRs of 145, 5.8, and 6.0, respectively.
  • CD4+ T-cells values at diagnosis were found to be a significant predictor of cancer incidence, with those having CD4+ < 200 cells/mml showing the highest cancer incidence after 5 years

Implications and Future Directions

  • The study underscores the need for continued prevention efforts in HIV-positive individuals, including behavioral risk reduction, early antiretroviral therapy initiation, screening, and vaccination.
  • Future research should investigate the optimal timing and duration of antiretroviral therapy to minimize cancer risk in HIV-positive individuals.
  • Additionally, studies should examine the role of immune reconstitution and viral suppression in preventing cancer in HIV-infected individuals.
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