Penile cancer more common among men living with HIV than HIV-negative men, reports large US study

Men living with HIV have a higher risk of developing penile cancer than HIV-negative men, especially if they have condyloma, a low CD4 count, or a detectable HIV viral load, an analysis of data from U.S. veterans showed.

About This Study

“Risk and predictors of penile cancer in US Veterans with HIV” was published online on April 23, 2024, in AIDS. The lead author is Jing Zhao, Ph.D., M.P.H., of the Department of Medicine in the Section of Epidemiology and Population Sciences at the Dan L. Duncan Comprehensive Cancer Center of the Baylor College of Medicine in Houston, Texas.

Key Research Findings

Based on data from the U.S. Veterans Administration’s health care system, this nationwide retrospective matched cohort study compared penile cancer rates between 44,173 men living with HIV (57 of whom had penile cancer) and 159,443 age-matched HIV-negative men (50 of whom had penile cancer). The data were collected between 1999 and 2016. The two cohorts differed significantly and study analysis included diagnoses of condyloma, a condition caused by the human papillomavirus and used as a proxy for HPV infection.

After adjusting data for body mass index, smoking status, alcohol use, race/ethnicity, condyloma diagnosis, and other variables, the adjusted hazard ratio for penile cancer was 2.63 in men living with HIV compared to men not living with that virus, and 4.25 without adjustment for condyloma. In the cohort living with HIV, penile cancer risk was especially high among those who had a low nadir CD4 cell count, a detectable viral load for ≥50% of the study period, or condyloma.

Discussion Highlights and Implications for Practice

One study limitation reported was the use of condyloma as a proxy for HPV infection, which may underestimate such infections but may increase the likelihood of penile cancer detection when condyloma lesions are biopsied. In addition, data came only from U.S. veterans, so results may not be transferrable to the general population. The study’s retrospective nature and reliance on codes in the medical record for variables are other limitations.

The authors suggested that HPV vaccination in younger men could lower the risk of developing condyloma while older men living with HIV who are diagnosed with condyloma should be monitored closely for penile cancer. Early HIV diagnosis and effective antiretroviral treatment could also reduce this cancer risk by keeping CD4 cell counts high and viral loads low, the researchers said.

By Barbara Jungwirth