Background
Data are limited on the incidence of cancers and associated risk factors among women with HIV and were hence investigated in two large international HIV cohort collaborations – D:A:D and RESPOND, between 2006 and 2022.
Methods
We included all women (sex assigned at birth) ≥18 years and investigated the incidence and risk factors of the most common cancers combined (i.e., lung, breast, non-Hodgkin’s lymphoma, cervical, anal, head & neck and other non-cervical gynecological cancers), specifically for women (breast, cervical and other gynecological cancers) and HPV-related cancers (cervical, head & neck, other non-cervical HPV-related gynecological and anal cancers). Baseline was defined as the latest of the date into a local cohort enrolment, or 1st January 2006 for the D:A:D cohort, and 1st January 2012 for the RESPOND cohort. Crude incidence rates (95% confidence intervals, CI) of each cancer group were determined and multivariable Poisson regression with robust standard errors was used to assess factors associated with incident cancers.
Results
Among 17,512 women included, median age was 39.5 years at baseline, most were from cohorts in Western Europe (45%), with 27% being ART-naïve overall. Median (interquartile range, IQR) baseline and pre-ART nadir CD4 count was 458 (306-654) and 223 (110-363) cells/µL and 21% had prior AIDS diagnosis. During 141,404 person-years (PY) and a median 9.2 (5.5-10.1) years of follow-up, 539 had one of the common cancers (149 breast, 91 lung and 83 cervical, 70 NHL, 58 non-cervical gynecological, 46 head & neck and 42 anal cancers); incidence rate 3.8 [95%CI, 3.5-4.2]/100 PY, 291 had a women-specific cancer (2.1 [1.8-2.3]/100 PY) and 163 had a HPV-related cancer (1.1 [1.0-1.3]/100 PY) (Figure). In adjusted analyses, age 45-55 and >55 (vs. <45) years, history of injecting drug use, Southern Europe (vs. Western Europe) and current smoking were associated with an increased risk of the most common cancers. Lower pre-ART nadir CD4 count, time-updated CD4 count, and AIDS events were associated with an increased risk of the most common cancers, HPV-related and lung cancers.
Conclusions
The most common incident cancers in women with HIV in the combined D:A:D and RESPOND collaborations were breast, lung and cervical cancers. Our study suggests that particularly immunosuppressed women with HIV older than 40 years who have a history of injection drug use and are current smokers should be considered for intensified cancer prevention measures and cancer screening.
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