Estimates of the global burden of HIV-attributable and all-cause AIDS-defining cancers: a population-based modeling study.

INTRODUCTION: People living with human immunodeficiency virus (HIV; PLHIV) have elevated risks of AIDS-defining cancers (ADCs), including cervical cancer, non-Hodgkin lymphoma (NHL), and Kaposi sarcoma (KS). Previous studies have quantified the individual global burden of these cancers, we aimed to estimate the pooled global burden of HIV-attributable and all-cause ADCs in 2022 and identify the key drivers across different regions and countries. METHODS: We conducted a systematic review and meta-analysis to update risk ratios (RRs) for cervical cancer, NHL, and KS. RRs were used to calculate population-attributable fractions (PAFs) and age-standardized incidence rates (ASIRs) of HIV-attributable ADCs using country-specific HIV prevalence and 2022 cancer incidence data. Associations with the Human Development Index (HDI) were assessed. RESULTS: In 2022, an estimated 101,835 (95% CI 76102-131,298) ADC cases were attributable to HIV, accounting for 8.1% (95% CI 6.2-10.4) of all-cause ADC cases. NHL comprised 62.9% of HIV-attributable ADCs, while cervical cancer accounted for 53.0% of all cases. The highest HIV-attributable ASIRs were in Eswatini (34.9%), Zambia (32.0%), and Mozambique (25.9%). In East and Southern Africa, 27.8% of ADCs were linked to HIV. Among 35 countries with high cancer burden and HIV attribution, 68.6% were in Africa. Lower HDI correlated with higher PAF (r = -0.27), all-cause ASIR (r = -0.25), and HIV-attributable ASIR (r = -0.28). CONCLUSION: HIV significantly contributes to the global ADC burden. Addressing immunosuppression, viral co-infections, and healthcare access through ART expansion, oncogenic virus monitoring, and cancer prevention is essential to mitigate the dual burden of HIV and ADCs globally.