Changes in the prevalence of non-AIDS conditions among hospitalized persons with HIV in the United States and Canada, 2008-2018

Background: Oropharyngeal squamous cell carcinoma (OPSCC) incidence has increased significantly in recent decades, particularly among people with HIV (PWH). Risk factors specific to PWH are understudied. Understanding these factors could inform future screening strategies in this population. Our aims were to describe incidence of OPSCC among PWH, and associated risk factors.
 
Methods: We analyzed cancer risk factors and OPSCC incidence spanning 2000-2020 among 21 cohorts of PWH with validated cancer diagnoses participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). We followed people from the latest of: enrollment, cohort open, cancer outcome ascertainment start, or January 1, 2000, until the earliest of: validated OPSCC diagnosis, death, loss to follow-up, cohort close, end of cancer outcome ascertainment, administrative censoring or December 31, 2020. Risk factors of interest included age, sex at birth, race/ethnicity, HIV-related variables (CD4 nadir and viral load peak), and smoking history. We calculated incidence rates (IRs) and mutually adjusted incidence rate ratios (aIRR) using Poisson regression models.
 
Results: Among 135,356 PWH (1,048,836 person-years [PY]), there were 254 incident OPSCC diagnoses (IR: 24.2 per 100,000 PY). OPSCC rates per 100,000 PY rose from 15.7 in 2000 to 42.3 in 2020 (P for trend 0.001). PWH aged 50-59 years had the highest OPSCC incidence (IR: 41.0 per 100,000 PY; aIRR: 2.5 versus PWH 40-49 years, 95% CI: 1.7,3.4) with similar risk estimates at older ages. Females were 50% less likely than males to have incident OPSCC (aIRR: 0.5, 95% CI: 0.3,0.8). PWH with CD4 nadir of 200 cells/μL (IR: 29.9 per 100,000 PY), were almost two-times as likely to have incident OPSCC compared to those with CD4 nadir ≥500 (IR: 13 per 100,000 PY; aIRR: 1.9, 95% CI: 1.2,3.4). OPSCC incidence was highest in heterosexual men (40.6 per 100,000 PY; aIRR: 1.5 versus MSM, 95% CI: 1.1,2.2). Ever smoking was associated with increased rate of OPSCC (aIRR: 1.4, 95% CI: 1.0,1.9) compared with never smokers. We found no differences by race, ethnicity, or HIV viral load.
 
Conclusions: The OPSCC incidence has tripled in PWH over the past 20 years. Our findings show higher OPSCC risk among men (particularly those that identify as heterosexual), age 50 and above, and with immunosuppression. Closer monitoring for OPSCC might be warranted for certain PWH.