Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration

Alisa Timiryasova; Lauren Greenberg; Pere Domingo; Philip E. Tarr; Alexander Egle; Charlotte Martin; Cristina Mussini; Ferdinand Wit; Antonella Cingolani; Clara Lehmann; Antonella Castagna; Kathy Petoumenos; Caroline A. Sabin; Fabrice Bonnet; Jens Lundgren; Martina Bottanelli; Sean Hosein; Christina Carlander; Alain Amstutz; Katharina Grabmeier-Pfistershammer; Harmony Garges; Andrea Marongiu; Lital A. Young; Lars Peters; Lene Ryom; on behalf of the D:A:D and RESPOND Study groups

doi:10.3390/cancers17244000

Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration

Alisa Timiryasova^*, Lauren Greenberg, Pere Domingo, Philip E. Tarr, Alexander Egle, Charlotte Martin, Cristina Mussini, Ferdinand Wit, Antonella Cingolani, Clara Lehmann, Antonella Castagna, Kathy Petoumenos, Caroline A. Sabin, Fabrice Bonnet, Jens Lundgren, Martina Bottanelli, Sean Hosein, Christina Carlander, Alain Amstutz, Katharina Grabmeier-PfistershammerHarmony Garges, Andrea Marongiu, Lital A. Young, Lars Peters, Lene Ryom, on behalf of the D:A:D and RESPOND Study groups

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Background/Objectives:
Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer.

Methods:
Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations.

Results:
Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/µL) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL.

Conclusions:
Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring.

Original language	English
Article number	4000
Number of pages	22
Journal	Cancers
Volume	17
Issue number	24
DOIs	https://doi.org/10.3390/cancers17244000
Publication status	Published - 16 Dec 2025

Bibliographical note

Publisher Copyright:
© 2025 by the authors.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

comorbidities
non-fatal clinical outcomes
HIV
immune status
cancer
mortality
modifiable risk factors

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Timiryasova, A., Greenberg, L., Domingo, P., Tarr, P. E., Egle, A., Martin, C., Mussini, C., Wit, F., Cingolani, A., Lehmann, C., Castagna, A., Petoumenos, K., Sabin, C. A., Bonnet, F., Lundgren, J., Bottanelli, M., Hosein, S., Carlander, C., Amstutz, A., ... on behalf of the D:A:D and RESPOND Study groups (2025). Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration. Cancers, 17(24), Article 4000. https://doi.org/10.3390/cancers17244000

@article{14d6355151954326bf2213c80074dd6b,

title = "Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration",

abstract = "Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer. Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi{\textquoteright}s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations. Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95\% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40\% (per 100 cells/µL) after NHL and anal and lung cancers and reduced CCO risk by 17–28\% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL. Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring.",

keywords = "comorbidities, non-fatal clinical outcomes, HIV, immune status, cancer, mortality, modifiable risk factors",

author = "Alisa Timiryasova and Lauren Greenberg and Pere Domingo and Tarr, \{Philip E.\} and Alexander Egle and Charlotte Martin and Cristina Mussini and Ferdinand Wit and Antonella Cingolani and Clara Lehmann and Antonella Castagna and Kathy Petoumenos and Sabin, \{Caroline A.\} and Fabrice Bonnet and Jens Lundgren and Martina Bottanelli and Sean Hosein and Christina Carlander and Alain Amstutz and Katharina Grabmeier-Pfistershammer and Harmony Garges and Andrea Marongiu and Young, \{Lital A.\} and Lars Peters and Lene Ryom and \{on behalf of the D:A:D and RESPOND Study groups\}",

note = "Publisher Copyright: {\textcopyright} 2025 by the authors.",

year = "2025",

month = dec,

day = "16",

doi = "10.3390/cancers17244000",

language = "English",

volume = "17",

journal = "Cancers",

issn = "2072-6694",

publisher = "MDPI AG",

number = "24",

}

Timiryasova, A, Greenberg, L, Domingo, P, Tarr, PE, Egle, A, Martin, C, Mussini, C, Wit, F, Cingolani, A, Lehmann, C, Castagna, A, Petoumenos, K, Sabin, CA, Bonnet, F, Lundgren, J, Bottanelli, M, Hosein, S, Carlander, C, Amstutz, A, Grabmeier-Pfistershammer, K, Garges, H, Marongiu, A, Young, LA, Peters, L, Ryom, L & on behalf of the D:A:D and RESPOND Study groups 2025, 'Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration', Cancers, vol. 17, no. 24, 4000. https://doi.org/10.3390/cancers17244000

TY - JOUR

T1 - Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV

T2 - A Multicohort Collaboration

AU - Timiryasova, Alisa

AU - Greenberg, Lauren

AU - Domingo, Pere

AU - Tarr, Philip E.

AU - Egle, Alexander

AU - Martin, Charlotte

AU - Mussini, Cristina

AU - Wit, Ferdinand

AU - Cingolani, Antonella

AU - Lehmann, Clara

AU - Castagna, Antonella

AU - Petoumenos, Kathy

AU - Sabin, Caroline A.

AU - Bonnet, Fabrice

AU - Lundgren, Jens

AU - Bottanelli, Martina

AU - Hosein, Sean

AU - Carlander, Christina

AU - Amstutz, Alain

AU - Grabmeier-Pfistershammer, Katharina

AU - Garges, Harmony

AU - Marongiu, Andrea

AU - Young, Lital A.

AU - Peters, Lars

AU - Ryom, Lene

AU - on behalf of the D:A:D and RESPOND Study groups

PY - 2025/12/16

Y1 - 2025/12/16

N2 - Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer. Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations. Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/µL) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL. Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring.

AB - Background/Objectives: Whilst cancer is a leading cause of death in people with HIV, less is known about clinical outcomes after cancer. Methods: Participants from the RESPOND and D:A:D cohorts with the five most common cancers (Kaposi’s sarcoma (KS); non-Hodgkin lymphoma (NHL); and lung, anal and prostate cancers) were followed from first cancer diagnosis after 2006/2012 [D:A:D/RESPOND] until death, final follow-up or administrative censoring (2016/2021). Incidence rates (IR) were calculated for post-cancer mortality; for non-fatal events (cardiovascular disease, diabetes, another primary cancer, AIDS events) individually and as a non-fatal composite clinical outcome (CCO). Predictors or mortality and CCO were assessed using Poisson regression with generalized estimating equations. Results: Amongst 2485 participants with cancer, mortality and CCO IRs were highest after lung cancer (445.4/1000 person years [95% CI 399.7, 494.9], 117.1 [94.3, 143.8], respectively) compared to other cancers and lowest after KS (21.3 [16.9, 26.6], 43.9 [37.5, 51.3]). The most common non-fatal outcomes were AIDS events after NHL and KS, diabetes after lung and prostate cancer and another primary cancer after anal cancer. Among people with NHL and anal cancer, a diagnosis in more recent years was associated with lower mortality risk. Increasing the time-updated CD4 count reduced mortality by 15–40% (per 100 cells/µL) after NHL and anal and lung cancers and reduced CCO risk by 17–28% after KS and NHL. Smoking, low BMI and multimorbidity increased CCO risks by two to three times after KS and NHL. Conclusions: Risk of post-cancer mortality and non-fatal outcomes varies by cancer type and risk profile, suggesting the need for personalized post-cancer clinical monitoring.

KW - comorbidities

KW - non-fatal clinical outcomes

KW - HIV

KW - immune status

KW - cancer

KW - mortality

KW - modifiable risk factors

U2 - 10.3390/cancers17244000

DO - 10.3390/cancers17244000

M3 - Article (Academic Journal)

SN - 2072-6694

VL - 17

JO - Cancers

JF - Cancers

IS - 24

M1 - 4000

ER -

Mortality and Non-Fatal Clinical Outcomes After the Most Common Cancers in People with HIV: A Multicohort Collaboration

Abstract

Bibliographical note

UN SDGs

Keywords

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