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Comparative Study
. 2025 Sep 15;157(6):1142-1153.
doi: 10.1002/ijc.35493. Epub 2025 May 29.

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

Pierluca Piselli  1 , Alessandro Tavelli  2   3 , Claudia Cimaglia  1 , Camilla Muccini  4 , Alessandra Bandera  5 , Giulia C Marchetti  6 , Carlo Torti  7 , Valentina Mazzotta  1 , Luca Pipitò  8 , Alessandro Caioli  1 , Enrico Girardi  1 , Andrea Antinori  1 , Diego Serraino  9 , Antonella d'Arminio Monforte  2 , Antonella Cingolani  7 ; Icona Foundation Study Group
Collaborators, Affiliations
Comparative Study

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

Pierluca Piselli et al. Int J Cancer. .

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/mm3 at 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.

Keywords: AIDS; HIV; cancers; incidence; risk.

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Conflict of interest statement

Enrico Girardi received a research grant from Gilead Sciences and speaker fees from ViiV healthcare and Gilead Sciences. Andrea Antinori served as paid consultant for AstraZeneca, Gilead, MSD, Janssen‐Cilag, GSK, Moderna, Pfizer, Bavarian Nordic, ViiV Healthcare and received institutional grants from Gilead, AstraZeneca, ViiV Healthcare. Alessandra Bandera reported a potential conflict of interest with Gilead (grant for data publication), AstraZeneca, Biomerieux, Qiagen, Janssen‐Cilag, Nordic Pharma, Pfizer, ViiV, Sobi, Angelini Pharma. The other authors declare no conflict of interest related to the present manuscript.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of de novo malignancies (not including skin non‐melanoma cancers), according to diagnostic group and time since first HIV‐positive test: ICONA Cohort Study: Italy, 1997–2023.
FIGURE 2
FIGURE 2
Comparison of age specific cancer incidence rates by cancer types in the ICONA cohort versus the general population. Panel (A): All, but non‐melanoma skin cancers; panel (B): Virus‐related malignancies; panel (C): Non‐virus related malignancies.
FIGURE 3
FIGURE 3
Standardized incidence ratios (SIR) and 95% confidence intervals (CI) for incident cancers. ICONA.
FIGURE 4
FIGURE 4
Cumulative incidence of malignancies since initiation of combination antiretroviral therapy (cART)according to CD4+ count. ICONA Cohort Study: Italy, 1997–2023.
See this image and copyright information in PMC

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