Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration
Within the D:A:D and RESPOND collaborations, Timiryasova A et al investigated mortality and non-fatal clinical outcomes following diagnosis of the five most common cancers among people with HIV: Kaposi’s sarcoma, non-Hodgkin lymphoma, lung, anal and prostate cancer. They included 2485 participants with cancer and followed participants after cancer diagnosis for mortality and non-fatal outcomes, including cardiovascular disease, diabetes, another primary cancer and AIDS-defining events.
During a median follow-up of around 3 years, mortality differed substantially according to cancer type. Mortality was highest following lung cancer (445/1000 person-years), with 49% of participants dying within one year and 64% within three years, and lowest following Kaposi’s sarcoma (21/1000 person-years). Cancer was the leading underlying cause of death for all five cancers. A more recent diagnosis of non-Hodgkin lymphoma or anal cancer was associated with lower mortality.
Non-fatal outcomes also varied by cancer type. AIDS-defining events were most common following non-Hodgkin lymphoma and Kaposi’s sarcoma, diabetes following lung and prostate cancer, and another primary cancer following anal cancer. Higher CD4 cell counts were associated with lower mortality after non-Hodgkin lymphoma, anal and lung cancer and with fewer non-fatal outcomes after Kaposi’s sarcoma and non-Hodgkin lymphoma. Smoking, low body mass index and multimorbidity were associated with higher risks of non-fatal outcomes, particularly following Kaposi’s sarcoma and non-Hodgkin lymphoma.
In conclusion, the study found substantial differences in clinical outcomes following common cancers in people with HIV, with particularly high mortality following lung cancer. Higher CD4 cell counts were consistently associated with better outcomes, highlighting the importance of immune recovery. The findings further underline the need for individualized post-cancer care addressing comorbidities and modifiable risk factors in people with HIV.