Failure to restore CD4 count associated with infection-related and non-infection-related cancer.

Objective To assess incidence and relative risk of cancer in Sweden, by HIV-status, from 1988 to 2017. Design Population-based register study. Methods From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983-2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and non-infection related cancer for three periods between 1988 and 2017. Results Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44% vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV (adjHR 0.6, 95% CI 0.4-0.9), mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0-0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2-0.5) was associated with lower risk of infection-related cancer. Current CD4 count Conclusion Current CD4 count and failure to restore CD4 count both associated with infection and non-infection related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.