HPV-associated cancers among people living with HIV - nationwide population-based retrospective cohort study 2004-21 in Estonia

Sep 21, 2026

Cancers are the leading cause of death among people living with HIV (PLWH), yet nationwide evidence on cancer incidence remains limited. This study evaluates incidence rates of cancers, with emphasis on human papillomavirus (HPV)-associated cancers, using Estonian Health Insurance Fund and National Cancer Registry data from 2004–2021. Among 7,011 PLWH, HPV-associated cancers represented 21.4% of incident cases, with elevated standardized incidence ratios in both men and women, supporting intensified screening, vaccination, and improved antiretroviral therapy adherence.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Background: cancer burden in PLWH

HPV as a precursor and related risks

Infection persistence and shared transmission pathways

European Journal of Public Health, Vol. 34, No. 6, 1199–1204 © The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. [https://doi.org/10.1093/eurpub/ckae152](https://doi.org/10.1093/eurpub/ckae152) Advance Access published on 8 October 2024 HPV-associated cancers among people living with HIV: nationwide population-based retrospective cohort study 2004–21 in Estonia Anna Tisler 1, 􀀃 , Karolin Toompere 1, Marc Bardou2, Jose Diaz3, Madleen Orumaa4, Anneli Uusk €ula 1 1 Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia 2CIC-P INSERM 1432, Centre Hospitalier Universitaire de Dijon, Dijon, France 3Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States 4Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway 􀀃 Corresponding author. Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, Tartu, 50411 Estonia. E-mail: [anna.tisler@ut.ee](anna.tisler@ut.ee) Abstract Cancers represent the primary cause of mortality among people living with HIV (PLWH) . However, comprehensive nationwide data regarding cancer incidence remains limited. Our objective was to evaluate the incidence rates of cancers, particularly those associated with human papillomavirus (HPV), within a nationwide study cohort. Using data from the Estonian Health Insurance Fund and the National Cancer Registry from 2004 to 2021, we calculated standardized incidence ratios (SIRs) for various cancer types among PLWH to compare to the general population with special emphases on HPV-associated cancers. A total of 7011 individuals (65.7% men) diagnosed with HIV were identified. HPV-associated cancers accounted for 21.4% of all incident cancer cases among PLWH. SIRs for HPV-associated cancers were 3.7 [95% confidence interval (CI) 2.2–6.2] among men living with HIV (MLWH) and 5.7 (95% CI 4.0–7.9) among women living with HIV (WLWH) . In MLWH, the highest SIRs were for penile 12.5 (95% CI 4.0–38.7), followed by oropharyngeal 3.6 (95% CI 1.7–7.6) and anal–rectal cancers 2.7 (95% CI 1.1–6.4) in comparison to the general population. In WLWH, an increased incidence of cervical (SIR ¼ 5.8, 95% CI 3.9–8.5), oropharyngeal (SIR ¼ 6.1, 95% CI 1.5–24.3), and anal–rectal (SIR ¼ 3.6, 95% CI 1.2–11.2) cancers was observed. A significantly increased risk of AIDS-defining and non-AIDS-defining cancers is reported. We demonstrate a substantially heightened risk of HPV-associated cancers among PLWH compared to the general population, underscoring the imperative for intensified screening and scaled-up vaccination along with improvement in adherence to antiretroviral therapy. Introduction HIV has evolved into a manageable chronic condition with the widespread adoption of antiretroviral therapy (ART) significantly extending the lifespan and overall health of affected individuals. Shifts in the successful management of HIV have led to changes in mortality and morbidity among people living with HIV (PLWH), including increased rates of, and disproportionate burdens related to cancer. Examining cancer burdens among PLWH requires examining multiple forms of cancer, including those historically referred to as AIDS-defining and non-AIDS-defining cancers. Among AIDS-defining cancers, HIV-induced immune suppression has been shown to increase the risk of developing non-Hodgkin’s lymphoma and Kaposi’s sarcoma, two cancers that can signify advanced stages of HIV [ 1] . Notably, non-AIDS-defining cancers (e.g. Hodgkin’s lymphoma, lung cancer) have become the leading cause of de

FAQs

How much of all incident cancer cases among PLWH were HPV-associated?

HPV-associated cancers accounted for 21.4% of all incident cancer cases among PLWH.

What do the authors conclude about HPV-associated cancer risk and public health actions?

They report a substantially heightened risk of HPV-associated cancers among PLWH and emphasize intensified screening, scaled-up vaccination, and improved adherence to antiretroviral therapy.

Sep 21, 2026

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