HPV-associated Cancer Diagnoses and Mortality in People With HIV in South Carolina During the Antiretroviral Therapy Era

OBJECTIVES: We aimed to determine whether people with HIV (PWH) and HPV-associated cancers (HACs) were more likely to be diagnosed at younger ages, at more advanced stages, and have increased mortality. METHODS: This is a retrospective cohort study of people diagnosed with HACs in South Carolina between 1996 and 2021. Data were obtained from two statewide databases. PWH were classified by HIV/AIDS stage at the time of cancer diagnosis. χ2 tests were used to compare differences in age and stage at diagnosis. Survival analyses were performed to evaluate differences in mortality. RESULTS: Of 13,797 people diagnosed with HACs, 307 (2.2%) had HIV infection, and 90% (277) had a history of AIDS. Nearly half (41% n: 126) had a CD4 >500 at the time of cancer diagnosis. PWH were diagnosed with HACs at younger ages. Men with HIV (MWH) were more likely to be diagnosed with anal and penile cancers (p<.0001). MWH had an earlier cancer stage at diagnosis of HACs (p<.0001), but survival was unaffected by HIV. Women with HIV (WWH) were more likely to be diagnosed with vulvar cancer (p<.0001) at younger ages (p<.0001). WWH had a lower survival from oropharyngeal cancer (p=.003). CONCLUSIONS: PWH were diagnosed with anal, penile, and vulvar cancers more frequently. PWH were diagnosed with HACs at younger ages. MWH did not have increase cancer-related mortality, but WWH were more likely to die from oropharyngeal cancer. HPV immunization, increased awareness, and innovative screening practices may reduce disparities in HACs among PWH.