TOPLINE

People with HIV infection and solid organ transplant recipients had greater odds of developing human papillomavirus (HPV)-related cancers than unexposed control individuals, a study found. The strongest associations were seen with anal, penile, and vulvar cancers. Worse immune status, inadequate HIV viral suppression, transplant characteristics, and socioeconomic factors further increased cancer odds.

METHODOLOGY

• HPV causes most cervical cancers and contributes to anal, vulvar, vaginal, penile, and many oropharyngeal cancers. People with HIV infection and solid organ transplant recipients are at a heightened risk for HPV-related cancers due to impaired immune function; however, direct comparisons of these groups within the same population are limited.
• Researchers conducted a nested case-control study using incidence density sampling within the Swedish population, including individuals born between 1940 and 2000 who resided in Sweden from 1983 to 2024.
• A total of 32,093 patients with HPV-related cancer (65.5% female) were matched 1:10 with 320,930 unexposed individuals (308,507 unique individuals) on the basis of sex, year of birth, and region of birth.
• Exposure was defined as HIV infection or previous solid organ transplantation before the index date, and HPV-related cancers were identified through the Swedish Cancer Registry. The researchers examined the occurrence of anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers in the study population.

TAKEAWAY

• People with HIV infection and solid organ transplant recipients were more likely to have HPV-related cancers than unexposed individuals (adjusted odds ratios [aORs], 4.50 and 2.23, respectively).
• Among people with HIV infection, the highest odds were observed for anal cancer (aOR, 58.79), penile cancer (aOR, 8.05), and vulvar cancer (aOR, 7.76). Among solid organ transplant recipients, vulvar cancer (aOR, 7.07), penile cancer (aOR, 6.01), and anal cancer (aOR, 2.70) showed the highest increases.
• Among people with HIV infection, CD4 counts of less than 200 cells/μL (aOR, 5.90), a shorter duration of viral suppression (aOR, 7.04), and higher peak levels of plasma HIV RNA (aOR, 5.66) were associated with increased odds of HPV-related cancers. Among solid organ transplant recipients, higher odds were seen after heart (aOR, 2.91), lung (aOR, 2.71), and kidney (aOR, 2.17) transplantation and with a longer time since transplant, especially more than 20 years (aOR, 2.27).
• Among people with HIV infection, age below 50 years (aOR, 5.94) was associated with a higher risk; the risk remained elevated across education and income levels, with the highest risk seen among those born in Western and Central Africa (aOR, 13.13) and Eastern and Southern Africa (aOR, 8.45). Among solid organ transplant recipients, adults aged younger than 50 years (aOR, 4.16), those with medium (aOR, 3.24) or high (aOR, 2.97) education levels, and those with high income (aOR, 3.58) were more likely to develop HPV-related cancers.

IN PRACTICE

“These findings underscore the need for strengthened prevention, including timely HPV vaccination, improved screening, and optimized immunosuppressive management to reduce the burden of HPV-related cancer in these populations,” the authors of the study wrote.

SOURCE

The study, led by Eva Meglic, MSc, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, was published online on June 30 in JAMA Network Open.

LIMITATIONS

The study lacked data on smoking, alcohol use, and sexual behavior. Some cancer risk may have begun before transplant because no buffer period was used. A small number of people with HIV could have been misclassified as unexposed if diagnosed after cancer. Additionally, some migrants with HIV lacking residency were excluded.

DISCLOSURES

The study received funding from the Swedish Research Council and the Swedish Research Council for Health, Working Life and Welfare. Some authors reported receiving consulting fees or other support from Merck Sharp & Dohme, Gilead Sciences, GSK, and ViiV Healthcare outside the submitted work. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.