Risk of Cancer After Tuberculosis Disease Among People With HIV in Denmark: A Nationwide Population-Based Cohort Study.

Abstract

The long-term cancer risk following tuberculosis disease in people with human immunodeficiency virus (HIV) remains unclear. We aimed to assess cancer risk following tuberculosis in a nationwide cohort of people with HIV in Denmark. We conducted a population-based cohort study including all individuals enrolled in the Danish HIV Cohort Study from 1995 to 2020. Tuberculosis and cancer diagnoses were identified through nationwide registries. Incidence rates (IRs) and adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for time-varying CD4 count, age, sex, and Charlson Comorbidity Index (CCI). Additionally, we calculated aIRRs stratified by age group, sex, CCI, and CD4 count. Among 6135 people with HIV (median age, 37.1 years; 74.1% male), 319 had a tuberculosis diagnosis. During 62 878 person-years of follow-up (PYFU), 451 cancers were observed, including 55 lung cancers. The overall cancer IR among people with HIV without previous tuberculosis disease was 18.6 per 1000 PYFU (95% confidence interval [CI], 16.9-20.4), and 19.0 per 1000 PYFU (95% CI, 10.4-25.6) among people with HIV following tuberculosis (aIRR, 1.1; 95% CI, .7-1.8). For lung cancer, the aIRR after tuberculosis was 1.7 (95% CI, .5-5.5). In stratified analyses, aIRRs were slightly higher among women (1.3; 95% CI, .6-2.9) and those aged ≥50 years (1.4; 95% CI, .8-2.4). In this nationwide cohort of more than 6000 people with HIV followed for up to 25 years, we observed no increased risk of cancer following tuberculosis disease. These findings do not support changes to continued standardized cancer surveillance in people with HIV and tuberculosis.