Sex differences in cancer incidence among people with HIV infection in the United States.

Abstract

Males have a higher incidence of most non-reproductive cancers than females, which has often been attributed to differences in lifestyle or behaviors. We examined whether sex differences in cancer incidence are attenuated among immunocompromised adults. Using data from population-based linkage study of HIV and cancer registries (2001-2019), we estimated male-to-female incidence rate ratios (M:F IRRs) among people with HIV (PWH) for 20 cancer sites. We used Poisson regression to adjust for age, race/ethnicity, calendar year, HIV transmission category, and HIV diagnosis year. We compared the M:F IRRs among PWH (M:F IRRPWH) to M:F IRRs in the general population (M:F IRRGP) with a chi-square test. PWH contributed 3,956,838 person-years of follow-up (53.6% among males, 46.4% among females). The M:F IRRPWH was significantly attenuated compared to the M:F IRRGP for 9 cancer sites: tongue (M:F IRRPWH 1.39 vs. M:F IRRGP 2.94; P<0.0001), oropharynx (1.80 vs 4.74; P<0.0001), esophagus (1.36 vs 3.43; P<0.0001), colon (0.90 vs 1.19; P=0.0002), liver (2.20 vs 4.22; P < 0.0001), larynx (1.50 vs 4.32; P<0.0001), lung (0.92 vs 1.39; P < 0.0001), bladder (1.21 vs 3.02; P<0.0001), and diffuse large B-cell lymphoma (1.35 vs 1.65; P<0.0001). Hodgkin lymphoma was the only site where the M:F IRRPWH was significantly larger than the M:F IRRGP (1.96 vs 1.45; P=0.0001). Although the incidence of most cancers remained higher among male than female PWH, the sex difference was attenuated among PWH for 9 cancers, suggesting that important immune differences between males and females in the general population contribute to differences in cancer incidence.