Abstract
Objectives: Among people with HIV (PWH), the epidemiology of malignant tumors has shifted from AIDS-defining malignancies (ADMs) to non-AIDS-defining malignancies (NADMs). This study examined temporal changes in the standardized incidence ratio (SIR) of malignant tumors in an HIV cohort in Japan. Methods: A retrospective cohort study was conducted of 3793 men treated for HIV at Osaka National Hospital between 2007 and 2024. Diagnoses of malignant tumors were identified from medical records and the expected numbers of cases were calculated using cancer incidence rates for the general male population of Japan. SIRs and 95% confidence intervals (CIs) were calculated and temporal changes across four periods (2007-2011, 2012-2016, 2017-2020, and 2021-2024) were evaluated using the p for trend. Results: The overall SIR for malignant tumors decreased from 5.12 (95% CI: 4.02-6.43) in 2007-2011 to 0.86 (95% CI: 0.64-1.14) in 2021-2024, mainly owing to a decline in ADMs (SIR: 111.93 to 5.70), including Kaposi's sarcoma (SIR: 4269.39 to 547.26) and AIDS-related lymphoma (SIR: 62.18 to 3.13). The overall SIR for NADMs was similar to that of the general population (1.04; 95% CI: 0.89-1.22), and decreased from 1.64 to 0.69, but the risks of anal cancer (SIR 40.63) and oral/pharyngeal cancer (SIR 3.16) remained high. Conclusions: Among men with HIV in Japan, the overall risk of ADMs and NADMs has decreased; however, the risk of specific NADMs remains high. Cancer prevention strategies for PWH need to focus on high-risk NADMs.