Cancer burden and risk factors among women with HIV: a multi-regional study from the D:A:D and RESPOND cohort collaborations
 Women with HIV face an increasing burden of non-AIDS-defining cancers, yet large-scale data on cancer incidence and associated risk factors specific to this population remain limited. In a study published in eClinicalMedicine, Han et al. investigated the cancer burden and key risk factors among women with HIV using combined data from the D:A:D and RESPOND cohort collaborations, to which the Swiss HIV Cohort Study contributes.
The study included 17’512 women with HIV aged 18 years or older, followed for a median of 9.2 years across clinical sites in Europe, Australia, and the United States. Cancer diagnoses were prospectively collected and centrally validated. Multivariable Poisson regression was used to identify risk factors, and population attributable fractions (PAFs) were estimated to quantify the contribution of modifiable and HIV-specific risk factors to cancer risk.
Over 141’404 person-years of follow-up, 832 women were diagnosed with cancer (incidence rate 5.9/1’000 person-years). The most common cancers were breast (n=150), lung (n=94), and cervical (n=83) cancers. Older age, current smoking, detectable HIV viral load, prior AIDS diagnosis, and lower CD4 cell counts were independently associated with increased cancer risk. In PAF analyses, smoking was the largest single contributor to overall cancer risk (PAF 22%), accounting for an estimated 46% of HPV-related cancers and 88% of lung cancers.
These findings highlight the importance of integrating cancer prevention into routine HIV care for women. Women with HIV who are older than 45, have a history of immunosuppression, or smoke may particularly benefit from intensified cancer screening. The results further underscore the value of early HIV diagnosis, sustained viral suppression, and smoking cessation in reducing cancer burden in this population.