HIV-associated malignancies in Tunisia: a 30-year retrospective cohort study from a North African perspective

Despite major advances in antiretroviral therapy (ART), HIV-associated malignancies remain a significant cause of morbidity and mortality in low- and middle-income countries. In Tunisia, data on AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) among people living with HIV (PLWH) remain scarce.

We conducted a descriptive retrospective cohort study over a 30-year period (1994-2024) at Farhat Hached University Hospital, Sousse, Tunisia. All PLWH who developed at least one malignant neoplasm were included. Epidemiological, clinical, immunovirological, pathological, and outcome data were retrospectively collected and analyzed.

Among 655 PLWH followed during the study period, 25 patients with a median age of 36 years developed malignancies, representing 3.8% of all PLWH. 27 malignancies were identified with 2 patients developing 2 distinct malignancies: a Kaposi sarcoma (KS) and a Non-AIDS-defining cancer (NADC). AIDS-defining cancers (ADC) predominated (81.5%), mainly KS (44.4%) and non-Hodgkin lymphoma (33.3%), while NADCs accounted for 18.5%. Cancer and HIV diagnoses were concomitant in 56% of patients (n = 14) and 92% of malignancies occurred within the first year following HIV diagnosis. Most patients presented with advanced immunodeficiency, with median CD4 counts at tumor diagnosis of 73 cells/mm³ for ADCs and 57 cells/mm³ for NADCs. Median overall survival was 1.9 years for ADCs and 3.7 years for NADCs.

In this North African cohort, HIV-associated malignancies were predominantly AIDS-defining and affected young adults with advanced immunosuppression, reflecting late HIV diagnosis for PLWH developing malignancies. Beyond strengthening early HIV testing and timely ART initiation, targeted patient education focusing on high-risk behaviors, along with efforts to reduce HIV-related stigma, are essential components to improve cancer prevention, early diagnosis, and outcomes among PLWH in resource-limited settings.