Trends in cancer incidence in different antiretroviral treatment-eras amongst people with HIV.  Cancers
Greenberg et al. on behalf of the RESPOND and D:A:D Study Groups aimed to assess changes in the incidence of both overall cancer and different types of cancer, including AIDS-defining cancers (ADCs), non-ADCs (NADCs), infection-related cancers, body mass index (BMI)-related cancers, and smoking-related cancers, from 2006 to 2021 in the D:A:D and the RESPOND international cohort collaborations.
Amongst 64’937 individuals (31% ART-naïve at baseline) and 490’376 total person years of follow-up (PYFU), there were 3’763 incident cancers (IR 7.7/1000 PYFU [95% CI 7.4, 7.9]): 950 ADCs, 2’813 non-ADCs, 1’677 infection-related cancers, 1’372 smoking related cancers, and 719 BMI-related cancers (groups were not mutually exclusive). Age-standardised IRs for overall cancer remained fairly constant over time (8.22/1000 PYFU [7.52, 8.97] in 2006–2007, 7.54 [6.59, 8.59] in 2020–2021). The incidence of ADCs (3.23 [2.79, 3.72], 0.99 [0.67, 1.42]) and infection-related cancers (4.83 [4.2, 5.41], 2.43 [1.90, 3.05]) decreased over time, whilst the incidence of non-ADCs (4.99 [4.44, 5.58], 6.55 [5.67, 7.53]), smoking-related cancers (2.38 [2.01, 2.79], 3.25 [2.63–3.96]), and BMI related cancers (1.07 [0.83, 1.37], 1.88 [1.42, 2.44]) increased. Trends were similar after adjusting for demographics, comorbidities, HIV-related factors, and ART use.
In conclusion, the study found that the age-standardised incidence of cancer overall has remained fairly constant over time from 2006 to 2021. ADCs and infection-related cancers have significantly decreased over time, whilst NADCs, smoking-related cancers, and BMI-related cancers have increased slightly. These results show the need for better prevention strategies to reduce the incidence of smoking- and BMI-related cancers, in particular. These data also suggest that initiatives to reduce the incidence of several infection-related cancers and ADCs, such as earlier HIV diagnosis and provision of ART, have been somewhat effective. Further research into individual cancer trends is needed to better understand the causes of the cancer trends presented in the presented study.