Risk of cancer in people with HIV experiencing different levels of immune recovery despite sustained viral suppression
Cancer remains a major cause of morbidity and mortality among people with HIV. Whether incomplete CD4 recovery continues to influence cancer risk once viral suppression is maintained has been unclear. In this large international study, Han et al. examined cancer risk in relation to immune recovery among people with HIV and a suppressed viral load using data from the D:A:D and RESPOND collaboration.
The analysis included 48’343 people with HIV from Europe and Australia who had been virologically suppressed for at least two years. During a median follow-up of 6.2 years, 1’933 incident cancers were diagnosed, corresponding to an incidence rate of 6.4 per 1’000 person-years. Higher recent CD4 cell counts were consistently associated with lower cancer risk. Compared with individuals with CD4 counts below 350 cells/µL, those with CD4 counts between 350 and 499, 500 and 749, and ≥750 cells/µL had progressively lower risks of cancer. Importantly, this association was observed across AIDS-defining and non–AIDS-defining cancers and was independent of pre-ART nadir CD4 cell counts.
In summary, this large multinational study shows that even among people with HIV with sustained viral suppression, suboptimal immune recovery is associated with a higher risk of cancer. These findings reinforce the importance of early HIV diagnosis and prompt ART initiation to support immune restoration and highlight the need for appropriate cancer screening and follow-up in individuals with persistently low CD4 cell counts despite effective treatment.