Cancer risks and trends between 1997 and 2018, and effects of restored immunity in people living with HIV: Results from the ANRS CO4 French hospital database on HIV.

We assessed long-term trends in cancer incidence among people with HIV (PWH) in France between 1997 and 2018, focusing on AIDS-defining cancers (ADC) (Kaposi's sarcoma, non-Hodgkin's lymphoma, and cervical cancer), three virus-related non-AIDS-defining cancers (Hodgkin lymphoma, liver, and anal cancer), and four virus-unrelated cancers (lung, colorectal, prostate, and breast cancer). Using data from the ANRS CO4-French Hospital Database on HIV and cancer registries in the general population, we calculated age-standardized incidence rates and standardized incidence ratios (SIRs) across four time periods. Special attention was given to PWH with controlled viral load and restored CD4 during 2008-2018. Among 154,733 individuals contributing nearly 2 million person-years, 9572 cancers were diagnosed. Incidence rates of ADC and virus-related non-ADC declined over time but remained significantly higher than in the general population, with SIRs ranging from 3 to 420, even in recent years. Rates of prostate and colorectal cancers increased overtime, while breast cancer incidence remained stable. For these three cancers, the relative risk compared to the general population remained close to 1. In PWH with CD4 ≥ 500/mm for at least 2 years and with recent viral load ≤50 copies/mL, risks of virus-related cancers (KS, NHL, HL, liver, and anal cancer) remained significantly higher relative to the general population, albeit to a lesser extent than in PWH overall, while risks of lung and cervical cancers were similar. Over 20 years, the incidence of all virus-related cancers continued to fall but in the most recent period, the risks still remained higher than in the general population.