Among adolescents and young adults (AYA) with HIV infection, infection-related cancers were the most commonly diagnosed type of cancer, and increased incident rates for these cancers were associated with decreased CD4 cell counts. These findings, from a nationwide cohort study, were published in Lancet HIV.
Data were sourced from the National Health Laboratory Services, which is the largest diagnostic service in South Africa, and from the National Cancer Registry. Patients (N=782,454) aged 15 to 24 years with HIV infection who had 2 or more HIV-related laboratory measurements between 2004 and 2014 were assessed for cancer diagnoses.
Among patients included in the study, 89.2% were girls or women, and the median CD4 count was 357 (interquartile range [IQR], 224-520) cells/mL.
During the 1,428,114 person-year follow-up, 0.1% of patients (n=867) developed cancer. The most commonly diagnosed cancers included Kaposi sarcoma (49%), non-Hodgkin lymphoma (12%), Hodgkin lymphoma (6%), cervical cancer (5%), and leukemia (3%). After stratification by patient age, the researchers found that the prevalence of noncervical carcinoma was increased among those aged 20 to 24 years (13%) compared with those aged 15 to 19 years (5%; P =.031).
Of note, all diagnosed cancers were found to be associated with male gender (adjusted hazard ratio [aHR], 2.16; 95% CI, 1.82-2.56) and ages between 20 and 24 years (aHR, 1.32; 95% CI, 1.08-1.61).
Compared with patients who had decreased CD4 cell counts (<200 cells/mL), those with moderate (200-499 cells/mL) or increased (³500 cells/mL) CD4 cell counts had a decreased risk for Kaposi sarcoma, cervical cancer, and non-Hodgkin lymphoma (all aHR <1.00). In addition, the risk for Hodgkin lymphoma was decreased among patients with moderate CD4 cell counts (aHR, 0.47; 95% CI, 0.23-0.95) but not among those with increased CD4 cell counts (aHR, 0.53; 95% CI, 0.24-1.20). No effect on the risk of developing leukemia was observed on the basis of patients’ CD4 cell counts.
This study was limited by its small sample size of patients with specific HIV-related cancer types and the potential underestimation of cancer rates among its patient population.
The researchers concluded that “innovative strategies for maintaining [increased] CD4 cell counts through early antiretroviral initiation and increased treatment adherence in AYA with HIV [infection] are needed to [decrease] the risk of developing cancer and other comorbidities in this vulnerable population.”
Ruffieux Y, Dhokotera T, Muchengeti M, et al. Cancer risk in adolescents and young adults living with HIV in South Africa: a nationwide cohort study. Lancet HIV. 2021;S2352-3018(21)00158-2. doi:10.1016/S2352-3018(21)00158-2