Cancer Incidence and Trends in US Adults With HIV

Importance: People with HIV are living longer due to improvements in antiretroviral therapy over the last 2 decades. Current age-specific estimates of cancer risk among people with HIV may inform cancer prevention and clinical guidelines for this population. Objective: To estimate cancer incidence rates (IRs) using a population-based linkage of HIV and cancer registries. Design, Setting, and Participants: This population-based cohort study used data from 12 US states, Washington, DC, and Puerto Rico from 2001 to 2019. People with HIV and the general population in the HIV/AIDS Cancer Match Study were included in the analysis, which occurred between October 2023 and December 2024. Main Outcomes and Measures: Age-standardized IRs (per 100 000 person-years) were calculated across calendar periods (2001 to 2004, 2005 to 2009, 2010 to 2014, and 2015 to 2019) and incidence rate ratios (IRRs) across calendar periods using adjusted Poisson regression. Standardized incidence ratios (SIRs) were estimated for 2010 to 2014 and 2015 to 2019, and age group-specific cancer incidence and SIRs were estimated for 2010 to 2019. Results: The analysis included 7.2 million person-years among 847 107 people with HIV (5.3 million person-years among males 73%). Comparing years 2015 to 2019 to years 2010 to 2014, incidence of diffuse large B-cell lymphoma (DLBCL) decreased 23% (IRR, 0.77; 95% CI, 0.70-0.84), Kaposi sarcoma (KS) decreased 24% (IRR, 0.76; 95% CI, 0.69-0.84), Hodgkin lymphoma decreased 25% (IRR, 0.75; 95% CI, 0.65-0.86), and cancers of the lung decreased 17% (IRR, 0.83; 95% CI, 0.77-0.90) and liver decreased 25% (IRR, 0.75; 95% CI, 0.67-0.84). Among people with HIV aged 70 to 84 years, IRs were highest for cancers of the prostate (448.01; 95% CI, 404.26-495.20), lung (269.79; 95% CI, 240.86-301.24), female breast (202.29; 95% CI, 155.79-258.32), liver (82.82; 95% CI, 67.16-101.03), and colon (107.57; 95% CI, 89.61-128.08), exceeding the IRs for DLBCL (41.83; 95% CI, 30.95-55.31) and KS (15.37; 95% CI, 9.11-24.29). From 2015 to 2019, risk remained significantly elevated in people with HIV for several cancer types, including KS (SIR, 213.87; 95% CI, 198.81-229.73), Hodgkin lymphoma (SIR, 6.29; 95% CI, 5.68-6.94), DLBCL (SIR, 5.25; 95% CI, 5.25-6.01), cancers of the anus (SIR, 17.07; 95% CI, 16.01-18.17), vulva (SIR, 11.40; 95% CI, 9.60-13.44), liver (SIR, 1.89; 95% CI, 1.74-2.05), and lung (SIR, 1.59; 95% CI, 1.51-1.68). For nearly all these cancers, SIRs significantly declined with increasing age. Conclusions and Relevance: In this cohort study, significant declines in the incidence and relative risk for cancers among people with HIV demonstrate continued progress in HIV treatment and cancer prevention. These estimates may provide insight into the priorities for prevention and early detection of cancer as the population of people with HIV enters ages with greater risk for cancer.