Racial disparities in cancer risk among MSM with HIV in the United States

Greater immunosuppression is associated with an elevated risk of virus-associated cancers among people with HIV. We investigated racial and ethnic disparities in cancer risk among MSM with HIV (MSMWH).

Among MSMWH from 2001 to 2019 in the HIV/AIDS Cancer Match Study, we examined Kaposi sarcoma, non-Hodgkin lymphoma (NHL), liver cancer, anal cancer, and Hodgkin lymphoma. Within racial/ethnic groups, we estimated cancer rates relative to the general population with standardized incidence ratios (SIRs). We calculated incidence rate ratios (IRRs) comparing cancer risk between racial/ethnic groups among MSMWH using Poisson regression. We stratified these calculations according to prior AIDS diagnosis to assess whether differences persisted after accounting for AIDS.

We evaluated 358 023 MSMWH followed for 3.2 million person-years. The SIRs for KS for Hispanic/Latino MSMWH [887; 95% confidence interval (95% CI) = 833-943] and Black MSMWH (772; 95% CI = 727-819) were higher than White MSMWH (417; 95% CI = 392-443). Among MSMWH, risk of Kaposi sarcoma was higher for Hispanic/Latino and Black MSMWH compared to White MSMWH (IRR = 1.40 and 1.24, respectively). We did not detect differences in IRRs when stratified by AIDS diagnosis. While the SIR for anal cancer was lower among Black MSMWH (24.1; 95% CI = 22.3-26.0) compared to White MSMWH (38.4; 95% CI = 36.3-40.6), incidence was not statistically different (IRR = 0.98; 95% CI = 0.89-1.08).

Incidence rates and relative risks for several virus-related cancers were greater for Hispanic/Latino and Black MSMWH than White MSMWH, even when examined exclusively among those with or without AIDS. These disparities in cancer risk point to inequities in access to HIV care and disease burden.