TOPLINE:

Initiating antiretroviral therapy (ART) within 1 year of HIV infections was associated with a substantially lower risk for any non-AIDS-defining malignancy than later initiation. This protective effect was independent of socioeconomic status and other traditional risk factors.

METHODOLOGY:

• Researchers analyzed data from 19,823 patients with HIV‑1 infection in the Netherlands, who had initiated ART between 2000 and 2022, to examine the effect of early ART initiation on the incidence of non‑AIDS‑defining malignancies.
• Patients with a follow-up duration of at least 6 months were classified as early ART starters (n = 1858; median age, 34.8 years; 5.4% women) if they had initiated ART within 365 days of the last negative HIV test and/or a clinically documented primary HIV infection; all others were designated as late ART starters (n = 17,965; median age, 39.0 years; 19.8% women).
• Comprehensive data on socioeconomic, demographic, and clinical variables including CD4 and CD8 cell counts were collected.
• The primary outcome was the occurrence of any non-AIDS-defining malignancy, excluding AIDS-defining malignancies, nonmelanoma skin cancer, and Castleman disease.
• The median follow-up duration was 79 months in the early-ART group and 113 months in the late-ART group.

TAKEAWAY:

• Patients in the early-ART group vs late-ART group were younger and had higher nadir CD4 counts (median, 478 vs 260 cells/µL).
• The incidence rate of non-AIDS-defining malignances was lower in the early-ART group vs late-ART group (incidence rate, 2.22 vs 4.87 per 1000 person-years of follow-up).
• Early ART initiation was associated with a 40% reduced risk for any non-AIDS-defining malignancy (hazard ratio [HR], 0.60; 95% CI, 0.40-0.91) and a similarly reduced risk for infection-unrelated non-AIDS-defining malignancy (HR, 0.60; 95% CI, 0.37-0.98).
• Results remained unchanged after adjusting for socioeconomic status and time‑updated CD4 and CD8 counts.

IN PRACTICE:

“The current study confirms that early use of ART is a vital intervention to diminish such effects [cellular immune dysfunction that occurs early after HIV infection] and reduce cancer risk among PWH [people with HIV],” an expert wrote in an accompanying editorial commentary.

SOURCE:

The study was led by Iris A.J. van der Wulp, Amsterdam UMC, University of Amsterdam, Department of Global Health, and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands. It was published online on November 5, 2025, in Clinical Infectious Diseases.

LIMITATIONS:

About half of the participants lacked data on the timing of HIV acquisition and were classified as late ART starters, which may have led to underestimation of the effect sizes. As this was an observational cohort, unmeasured confounders could have introduced bias despite adjustment for socioeconomic status. Adjustment for smoking and alcohol use was limited by the absence of detailed measures. 

DISCLOSURES:

This study received no specific funding. Some authors reported receiving advisory board fees, research grants and consulting fees, or independent scientific grant support from and/or serving on advisory boards for multiple pharmaceutical companies.

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