What question did this study set out to answer?

To evaluate the mortality risk in patients with urological malignancies who also have HIV coinfection.

March 5, 2026Open Access

Mortality Risk in Patients with Urological Malignancies and HIV Coinfection: A Systematic Review and Meta-Analysis of Cohort Studies

Key Points

To evaluate the mortality risk in patients with urological malignancies who also have HIV coinfection.
Conducted a systematic search across five databases up to July 2025.
Included nine cohort studies with over 6 million participants.
Utilized random-effects models to pool hazard ratios and assess publication bias.
Performed subgroup analyses for different cancer types and follow-up durations.
Prostate cancer patients with HIV have an adjusted hazard ratio (aHR) of 2.27 for mortality.
HIV-positive kidney cancer patients face a 74% higher mortality risk with an aHR of 1.74.
Bladder cancer patients with HIV show a significantly increased mortality risk with an aHR of 4.29, although data is limited.
Subgroup analyses indicated consistent trends in increased mortality risk for prostate cancer across different follow-up periods.

Abstract

The extended survival of people living with HIV (PLWH) has shifted cancer burdens toward urological malignancies. PLWH exhibit unique clinical patterns, including younger age at diagnosis for renal cell carcinoma and more advanced stage at manifestations for prostate and bladder cancers, which are compounded by health care access inequities and human immunodeficiency virus (HIV)-specific mechanisms such as chronic immunosuppression. A systematic search was conducted across five databases (Web of Science, PubMed, Cochrane Library, Embase, and Scopus) up to 1 July, 2025. Random-effects models were used to pool hazard ratios (HRs) and adjusted hazard ratios (aHRs). Publication bias was assessed using Egger's test, and sensitivity analyses were performed. Nine studies with 6,615,444 participants were included. The risk factors for mortality such as kidney cancer (aHR = 1.74; 95% CI: 1.11–2.75), prostate cancer (HR = 1.77; 95% CI: 1.60–1.96; aHR = 2.27; 95% CI: 1.77–2.90), and bladder cancer (aHR = 4.29; 95% CI: 1.08–17.03) were significantly higher for PLWH. The pooled unadjusted HR for kidney cancer was 1.66 (95% CI: 0.83–3.00) ,which did not reach statistical significance. Subgroup analyses for prostate cancer confirmed a consistent increase in mortality risk across different mortality types and follow-up durations. HIV infection is significantly associated with increased mortality among patients with prostate cancer. For kidney cancer, limited data suggest an adverse prognostic role of HIV. For bladder cancer, the evidence remains preliminary but highlights the urgent need for dedicated investigations. These findings highlight the need to integrate urological cancer screening and tailored management into long-term HIV care. Future multicenter studies will be essential to strengthen the evidence, particularly for kidney and bladder cancers, and to clarify the roles of HIV-specific factors, tumor biology, and social determinants of health in optimizing precision medicine for this population. • Prostate cancer patients infected with human immunodeficiency virus (HIV) have a significantly increased risk of mortality, with an aHR of 2.27. • Compared with their HIV-negative counterparts, HIV-positive kidney cancer patients have a 74% higher risk of mortality (adjusted hazard ratio aHR=1.74). • Although the data are limited, bladder cancer patients with HIV exhibited a more than fourfold increased risk of mortality (aHR=4.29).

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