Failure to restore CD4⁺ cell count associated with infection-related and noninfection-related cancer

Abstract

Objective: 

To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017.

Design: 

Population-based register study.

Methods: 

From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983–2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017.

Results: 

Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4–0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0–0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2–0.5) was associated with lower risk of infection-related cancer. Current CD4⁺ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7–21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5–4.1), as was CD4⁺ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2–10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2–3.3).

Conclusion: 

Current CD4⁺ cell count and failure to restore CD4⁺ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.