STOCKHOLM — A new study published in JAMA Network Open by Christina Carlander, MD, PhD, and colleagues at the Karolinska Institutet found higher risks of human papillomavirus (HPV)-related cancers in people with HIV and transplant recipients. The retrospective case-control study analyzed data from Swedish adults between 1983 and 2024.

The study cohort included 32,093 individuals who developed HPV-related cancers and 320,930 matched controls who did not have any HPV-related cancer. Approximately two-thirds of the study participants were women, and about 40% were younger than 50 years at the time of cancer diagnosis. Cervical cancer represented the most common HPV-related cancer within the cohort at 42% of cases, followed by oropharyngeal cancer at 35%.

People with HIV had an adjusted odds ratio of 4.50 for developing any HPV-related cancer when compared with age- and sex-matched controls in the general population. Transplant recipients had an adjusted odds ratio of 2.23 for developing any HPV-related cancer compared with controls. Among people with HIV, the adjusted odds ratio was 58.79 for anal cancer, 8.05 for penile cancer, 7.76 for vulvar cancer, and 2.55 for cervical cancer. Low CD4 counts also increased the odds of HPV-related cancers among people with HIV. Reduced income and not being married were also linked with greater odds of HPV-related cancers in people with HIV.

Among transplant recipients, specific cancers also showed increased risks. Heart transplant recipients had an adjusted odds ratio of 2.91 for developing HPV-related cancer, lung transplant recipients had an adjusted odds ratio of 2.71, kidney transplant recipients had an adjusted odds ratio of 2.17, and liver transplant recipients had an adjusted odds ratio of 1.89. For transplant recipients, the adjusted odds ratio for anal cancer was 2.70, for penile cancer it was 6.01, for vulvar cancer it was 7.07, and for cervical cancer it was 1.87. Associations with sociodemographic factors were less consistent in transplant recipients.

The study found no associations for HPV-related vaginal or oropharyngeal cancers in either people with HIV or transplant recipients. Penile cancer accounted for 5% of HPV-related cancers in the study cohort, while vulvar cancer was 7%, anal cancer was 9%, and vaginal cancer was 1%. The study did not include data on behavioral risk factors such as smoking, sexual behavior, and alcohol use.

Why It Matters

This study provides an analysis of HPV-related cancer risks in immunosuppressed populations over four decades. The findings indicate that people with HIV and transplant recipients face increased odds of developing certain HPV-related cancers. "Overall, our findings reinforce the importance of targeted prevention strategies in immunosuppressed populations and suggest that there is still room to improve both awareness and implementation of preventive measures in clinical practice," Eva Meglic, MSc, said. "The findings point to potential disparities in cancer prevention and diagnosis across both populations."