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

Abstract

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. χ 2 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.