What does this research mean for the field?

Among people with HIV, lower CD4 cell counts are significantly associated with increased cancer-specific mortality across multiple cancer types, including non-HIV-associated solid tumors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study investigates how low CD4 cell counts influence cancer-specific mortality among people with HIV and cancer.

May 31, 2026

Markers of immune function and survival among cancer patients with HIV in the United States: a population-based registry linkage study

Key Points

This study investigates how low CD4 cell counts influence cancer-specific mortality among people with HIV and cancer.
Analyzed linked data from 14 HIV and cancer registries in the US and Puerto Rico from 2008 to 2019.
Studied 12 common cancers and utilized Cox regression to estimate hazard ratios for CD4 count associations with mortality.
Estimated 3-year cancer-specific cumulative mortality using Fine-Gray models.
Cancer-specific mortality was significantly greater for CD4 counts of 0-49 compared to 200+ for multiple cancers: NHL (HR=1.82), prostate (HR=3.98), KS (HR=4.16), lung (HR=1.69), colorectal (HR=2.79), liver (HR=1.44).
3-year cumulative mortality for lung cancer was 52% for CD4 200+ versus 72% for CD4 0-49.
Mortality increased with lower CD4 counts even for solid tumors not directly related to HIV.

Abstract

Abstract Background People with HIV (PWH) and cancer have greater cancer-specific mortality than patients without HIV, which may reflect effects of immunosuppression. We aimed to describe the associations between low CD4 cell counts and cancer-specific mortality in PWH with cancer. Methods We used linked data from HIV and cancer registries to study 12 common cancers in PWH in 14 registries in the United States and Puerto Rico in 2008–2019. We used Cox regression to estimate hazard ratios (HRs) for the association of CD4 counts measured after cancer diagnosis (0–49, 50–99, 100-199, and 200+ CD4 cells/mm3) with cancer-specific mortality, adjusted for demographic and cancer-related factors. We estimated 3-year cancer-specific cumulative mortality using Fine-Gray models. Results We evaluated 12,087 PWH and cancer (the most common being non-Hodgkin lymphoma NHL, N=2311, prostate cancer N=1681, and Kaposi sarcoma KS, N=1423). Cancer-specific mortality was significantly greater for individuals with a CD4 count of 0-49 compared to 200+ cells/mm3 for NHL (HR=1.82, 95%CI=1.30–2.53), prostate cancer (HR=3.98, 95%CI=1.56–10.15), KS (HR=4.16, 95%CI=1.49–11.67), lung cancer (HR=1.69, 95%CI=1.33–2.14), colorectal cancer (HR=2.79, 95%CI=1.58–4.92), and liver cancer (HR=1.44, 95%CI=1.01–2.70). For lung cancer, those with a CD4 count of 200+ cells/mm3 had 3-year cancer-specific cumulative mortality of 52% versus 72% for those with a CD4 count of 0–49. Conclusion Among PWH with cancer, cancer-specific mortality increased with lower CD4 counts, including for solid tumors not associated with HIV, e.g., prostate and lung cancer. These results highlight the role of immunity in control of cancer.

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