As reported in JAMA Network Open by Meglic et al, a Swedish nested case-control study of immunosuppressed populations found that both people with human immunodeficiency virus (HIV) and solid organ transplant recipients had increased odds of human papillomavirus (HPV)–related cancers, although the magnitudes of associations were larger in the former group.
Differences by immune status, transplant characteristics, and sociodemographic factors further highlighted the role of impaired immunity, the investigators wrote.
They commented, “These findings underscore the need for strengthened prevention, including timely HPV vaccination, improved screening, and optimized immunosuppressive management to reduce the burden of HPV-related cancer in these populations.”
Study Details
Using incidence density sampling, the investigators examined the association between immunosuppression and HPV-related cancers among people born between 1940 and 2000 who resided in Sweden at any point from 1983 to 2024.
Each case of HPV-related cancer identified through the Swedish Cancer Registry was matched with 10 controls by sex, year of birth, and region of birth. The analysis included 32,093 people with HPV-related cancer and 320,930 matched control encounters from 308,507 unique individuals.
Key Findings
Compared with controls, both people with HIV (adjusted odds ratio [aOR] = 4.50, 95% confidence interval [CI] = 3.46–5.84) and solid organ transplant recipients (aOR = 2.23, 95% CI = 1.85–2.68) had increased odds of HPV-related cancers. Among people with HIV, anal cancer was associated with the greatest increase in odds (aOR = 58.79, 95% CI = 22.63–152.79), followed by penile cancer (aOR = 8.05, 95% CI = 3.38–19.16). Site-specific associations in solid organ transplant recipients were greatest for vulvar (aOR = 7.07, 95% CI = 4.31–11.60) and penile (aOR = 6.01, 95% CI = 3.47–10.52) cancers, with variation by transplanted organ and time since transplantation.
Among people with HIV, lower nadir CD4 counts (aOR = 5.90, 95% CI = 4.04–8.61), lower current CD4 counts (aOR = 8.62, 95% CI = 3.70–20.04), shorter duration of viral suppression (aOR = 7.04, 95% CI = 4.40–11.27), and higher peak plasma HIV RNA levels (aOR = 5.66, 95% CI = 2.96–10.84) were associated with increased odds of HPV-related cancers.
Secondary analyses showed that sociodemographic factors such as lower income and nonmarried status were associated with increased odds in both groups.
“These findings confirm that immunosuppressed populations have higher odds of HPV-related cancers, particularly at anogenital sites, and suggest that HIV duration, CD4 counts, sociodemographic factors, and transplant-related characteristics contribute to increased odds,” the investigators concluded.
Eva Meglic, MSc, of Karolinska Institutet, Stockholm, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was funded by the Swedish Research Council and Swedish Research Council for Health, Working Life and Welfare. For full disclosures of the study authors, visit jamanetwork.com.
