Non-AIDS-Defining Cancer Incidence in People With HIV in Milan, Italy, 2000-2023: Temporal Trends and Comparison With...

People with HIV (PWH) are living longer, but contemporary data on non-AIDS-defining cancers (NADCs) in Italy remain limited. We assessed incident cancers in a retrospective cohort of PWH in Milan, Italy, between January 2000 and December 2023. Follow-up was grouped into 2000-2007, 2008-2015, and 2016-2023. Incidence rates (IRs) were calculated per 100,000 person-years (PYs). Multivariable Poisson regression estimated adjusted (age, mode of HIV acquisition, and prior AIDS diagnosis) IR ratios (aIRRs) for first incident NADCs. Standardized incidence ratios (SIRs) compared observed cancers with expected cases in the general population. Among 4642 PWH contributing 50,086 PYs, 321 first incident NADCs were diagnosed. NADC incidence increased from 518 (95% CI 422-636) in 2000-2007 to 812 (95% CI 683-967) in 2016-2023. Non-virus-related cancer incidence increased from 293 to 582 per 100,000 PYs, whereas virus-related cancer incidence remained stable, from 225 to 230 per 100,000 PYs. People who inject drugs (PWID) versus heterosexuals (aIRR 1.71, 95% CI 1.33-2.20), and prior AIDS diagnosis (aIRR 1.33, 95% CI 1.05-1.69) were associated with higher NADC incidence. Compared with the general population, lung cancer incidence was increased in females (SIR 3.21, 95% CI 1.94-5.32). Anal cancer incidence was markedly elevated in both males and females (SIR 59.16, 95% CI 42.06-83.22 and 18.55, 95% CI 8.33-41.30, respectively). The excess cancer burden in this cohort was concentrated in selected NADCs, particularly anal cancer and, in females, lung cancer.