Background: The incidence of malignancy between 10-24 years of age in the general UK population is 0.2/1000 person-years. Adults living with HIV have an increased risk of malignancy yet there is a paucity of data for teenage young adults (TYA) living with perinatally acquired HIV (PaHIV).
Methods: Retrospective cohort analysis of all-cause mortality and malignancies in TYAPaHIV aged 10-24 years attending a tertiary unit from 01.01.2004 to 31.12.2017, assessing mortality, cancer presentation, immunology, virology and comparing incidence and mortality to aged-matched UK general population rates.
Results: 290 TYAPaHIV contributed 2644 person-years of follow up. 2/290 (0.7%) were lost to follow-up, 14/290 (4.8%) transferred care and 6/290 (2.0%) died within the study period at a median age of 17 years (inter-quartile range (IQR) 15-19). Cause of death; 3 with malignancy (non-Hodgkin''s lymphoma, hepatocellular carcinoma (HCC), gastrointestinal adenocarcinoma), 2 with end stage HIV with poor adherence to antiretroviral therapy (ART) and 1 with cryptococcal meningitis. Overall mortality rate was 2.3/1000 person-years, 9.4 times the age-matched general population (incidence rate ratio (IRR) 9.4, 95% confidence interval (CI) 3.4-20.4, p < 0.0001). 8/290 (2.8%) were diagnosed with a malignancy aged 10-24 years; 7/8 males; 6 with lymphoma (3 Hodgkin''s, 1 Burkitt''s, 2 B-cell) and one each with HCC and gastrointestinal adenocarcinoma. At cancer diagnosis the median age was 19 years (IQR 14-23), median CD4 count 453 cells/uL (IQR 231-645) and 4/8 had undetectable HIV viral load (< 50 copies/mL). Median length of HIV viraemia pre-cancer diagnosis was 15 years (IQR 12-17). 4/6 lymphomas presented with advanced disease (Ann Arbor stage III/IV). The incidence of a malignancy was 3.0/1000 person-years in TYAPaHIV, IRR to the age-matched general population 12.9 (95% CI 5.6 - 25.5, p < 0.0001), driven by lymphomas (IRR 44.2, 95% CI 16.1 - 96.7, p < 0.0001).
Conclusions: In this cohort, TYA living with PaHIV had nearly a ten-fold increased risk of all-cause mortality and of malignancy compared to their uninfected peers, with the excess in malignancy driven by lymphomas. It is hoped that earlier access to antiretroviral therapy will mitigate some of the risk for future generations.