Cancer incidence in people with HIV in Italy: Comparison of the ICONA COHORT with general population data

The cancer risk of people with HIV (PWH) enrolled in the Italian COhort of Naives to Antiretrovirals (ICONA) with HIV diagnosis occurred between 01/1997 and 12/2023 has been compared to that of the corresponding general population of Italy. Incident cancers were grouped according to their association with viral infections. Standardized incidence ratios (SIRs) were estimated as the ratio between the observed number of cancers among PWH and the expected ones among the general population. Competing risks cumulative incidence curves and Gray's test were used to compare incidence between groups (gender and CD4+ T-cells values at diagnosis) with death as a competing risk. Overall, 17,298 PWH (79.1% males) contributing to 133,851 person-years of follow-up were included; 763 (4.4%) developed > = 1 incident cancers, the most frequent cancers being KS (N = 204), NHL (N = 127) and lung-trachea-bronchus (N = 66). PWH were at 1.6-times higher risk for all cancers compared to the general population (SIR = 1.6, 95% CI: 1.5-1.8), with significantly increased SIR for almost all virus-related cancers, including KS (SIR = 145), NHL (SIR = 5.8), ICC (SIR = 6.0), anal cancer (SIR = 21.0) and Hodgkin lymphoma (SIR = 10.0). Apart from lung cancer risk (SIR = 1.3), none of the non-virus-related cancers turned out to be more frequent among PWH. PWH with CD4 + <200 cells/mm³ at cART initiation showed the highest cancer incidence, 5% after 5 years, versus 3% for CD4+ 200-349 and 2% for CD4+ >350 (p < .001). These findings underscore the need to continue prevention efforts in PWH, including behavioral risk reduction, early cART initiation, screening, and vaccination.