Table 1.

Etiology and incidence of cancers among PLWH

Etiologic virusCancer typeRole of immunosuppressionOther risk factorsSIR in the United States3,4 Comment
KSHV Kaposi sarcoma +++ Men who have sex with men 498 Very common in parts of sub-Saharan Africa 
EBV Non-Hodgkin lymphoma* ++ to ++++ HBV, HCV 12  
Hodgkin lymphoma ++ Male sex 7.7 Mixed cellularity is most common subtype 
HPV Anal cancer Tobacco, anal warts 19 Incidence increasing 
Cervical cancer Tobacco 3.2 Very common in resource-limited regions 
Oropharyngeal cancer Tobacco, alcohol 1.6-2.2 Incidence increasing 
Vulvar cancer Tobacco 9.4  
Penile cancer Tobacco, lack of circumcision 5.3  
HBV, HCV Hepatocellular cancer Alcohol, cirrhosis 3.2  
MCPyV Merkel cell carcinoma Sun exposure 2.6 At least 15% of cases not associated with MCPyV 
None or unknown Lung cancer Tobacco, pulmonary infections Most common cancer-related cause of death 
Nonmelanoma skin cancer Sun exposure, family history 2.1  
Conjunctival carcinoma Sun exposure 5.5 Rare in the United States; occurs most often in sub-Saharan Africa; viral etiology suspected 
Etiologic virusCancer typeRole of immunosuppressionOther risk factorsSIR in the United States3,4 Comment
KSHV Kaposi sarcoma +++ Men who have sex with men 498 Very common in parts of sub-Saharan Africa 
EBV Non-Hodgkin lymphoma* ++ to ++++ HBV, HCV 12  
Hodgkin lymphoma ++ Male sex 7.7 Mixed cellularity is most common subtype 
HPV Anal cancer Tobacco, anal warts 19 Incidence increasing 
Cervical cancer Tobacco 3.2 Very common in resource-limited regions 
Oropharyngeal cancer Tobacco, alcohol 1.6-2.2 Incidence increasing 
Vulvar cancer Tobacco 9.4  
Penile cancer Tobacco, lack of circumcision 5.3  
HBV, HCV Hepatocellular cancer Alcohol, cirrhosis 3.2  
MCPyV Merkel cell carcinoma Sun exposure 2.6 At least 15% of cases not associated with MCPyV 
None or unknown Lung cancer Tobacco, pulmonary infections Most common cancer-related cause of death 
Nonmelanoma skin cancer Sun exposure, family history 2.1  
Conjunctival carcinoma Sun exposure 5.5 Rare in the United States; occurs most often in sub-Saharan Africa; viral etiology suspected 
*

See Figure 2.

SIR is 1.6 for HPV-related cancers and 2.2 for HPV-unrelated cancers.

SIR, standardized incidence ratio; +, low; ++, moderate; +++, significant; ++++, very significant role for immunosuppression in pathogenesis.

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