Changing Prevalence of AIDS and Non-AIDS-Defining Cancers in an Incident Cohort of People Living with HIV over 28 Years

Abstract

Background: The introduction and evolution of antiretrovirals has changed the panorama of comorbidities in people living with HIV (PLWH) by reducing the risk of AIDS-defining cancers (ADC). By contrast, due to ageing and persistent inflammation, the prevalence and incidence of non-AIDS-defining cancers have significantly increased. Therefore, we aimed at describing cancer epidemiology in our cohort over 28 years.

Methods: We retrospectively included all PLWH in our clinic who ever developed cancers, considering features of ADC and NADC, from January 1996 to March 2023. Demographic, clinical characteristics, and survival were analyzed, comparing three observation periods (1996-2003, 2004-2013, and 2014-2023).

Results: A total of 289 PLWH developed 308 cancers over the study period; 77.9% were male, the mean age was 49.6 years (SD 12.2), and 57.4% PLWH developed NADC and 41.5% ADC. Kaposi (21.8%) and non-Hodgkin lymphoma (20.1%) were the most frequent cancers. Age at the time of cancer diagnosis significantly increased over time (41.6 years in the first period vs. 54.4 years in the third period, p < 0.001). In the first period compared with the last, a simultaneous diagnosis of HIV infection and cancer occurred in a higher proportion of persons (42.7 vs. 15.3, p < 0.001). While viro-immunological control at cancer diagnosis significantly improved over time, the proportions of cancer progression/remission remained stable. Overall survival significantly increased, but this trend was not confirmed for ADC.

Conclusions: The probability of survival for ADC did not decrease as significantly as the number of ADC diagnoses over time. By contrast, NADC dramatically increased, in line with epidemiological studies and other literature data. The changing patterns of malignancies from ADC to NADC underline the need for public health interventions and the fostering of screening programs aimed at the prevention and early detection of NADC in PLWH.

Keywords: AIDS-defining cancer; HIV; PLWH; cancer; epidemiology; malignancies; non-AIDS-defining cancer; tumor.

Figure 1

Annual raw incidence per 1000 PLWH of ADC and NADC over time.

Figure 2

Differences in time from HIV to cancer diagnosis between ACD and NADC over the three decades. Pairwise comparison p-values marked with * fall below the significance level under Bonferroni correction.

Figure 3

Survival probabilities for all periods (a), all tumor types (b), ADC (c), and NADC (d). Significance values for variations in long- (15-year) and short-term (2-year) survival by group were determined with the log-rank test.

Figure 4

Disease-free survival probabilities for all periods (a), all tumor types (b), ADC (c), and NADC (d). Significance values for variations in long- (15-year) and short-term (2-year) survival by group were determined with the log-rank test.

Figure 4

Disease-free survival probabilities for all periods (a), all tumor types (b), ADC (c), and NADC (d). Significance values for variations in long- (15-year) and short-term (2-year) survival by group were determined with the log-rank test.