Risk and predictors of penile cancer in US Veterans with HIV

Abstract

Objectives: People with HIV (PWH) may have an increased burden of penile cancer. We aimed to evaluate the risk of penile cancer in PWH compared with that of the general population. Design: We conducted a nationwide retrospective matched cohort study of penile cancer incidence among veterans with HIV (VWH) compared with veterans without HIV. Methods: We compared penile cancer incidence rates in 44 173 VWH to those of veterans without HIV (N = 159 443; 4 : 1 matched in age). We used Cox regression models to estimate hazard ratios and 95% confidence intervals (CIs) for associations with HIV infection and for penile cancer risk factors. Results: HIV positivity was associated with an increased risk of penile cancer, with adjusted hazard ratios of 2.63 (95% CI 1.64–4.23) when adjusting for age, race/ethnicity, baseline BMI, smoking and alcohol use, economic means test, and history of condyloma. The risk increased to hazard ratio = 4.25 (95% CI 2.75–6.57) when adjusting for all factors except history of condyloma. Risk factors for penile cancer in VWH included lower nadir CD4+ count, less than 50% of follow-up time with undetectable HIV viral load, and history of condyloma. Conclusion: VWH – particularly those with low CD4+ counts, detectable HIV viral loads, or history of condyloma – are at increased risk of penile cancer, suggesting the penile cancer prevention activities are needed in this population.