Cancer risk among women living with HIV: Implications for care in the modern cART era

Following the advent of modern combination antiretroviral therapy (cART) in 1996, a temporal decline was widely observed in AIDS-related morbidity and mortality. In the province of British Columbia (BC), universal provision of cART free-of-charge for people living with HIV (PLHW) has contributed in part to a significant demographic shift, with individuals over 50 years of age comprising over half of all PLHW. In this context there is a need to understand how comorbidities, such as cancer, impact this aging cohort. Within this line of inquiry, it is imperative to look at cancer risk specifically amongst women living with HIV (WLWH). The majority of studies looking at cancer as a co-morbid condition among PLWH fail to conduct sex-stratified analyses, which may obscure the burden of cancer risk specific to WLWH. Using a Life Course Epidemiology framework, the objectives of this PhD dissertation were to: 1) measure cancer incidence among WLWH in BC compared to a general population sample of women; 2) identify the role of early cART initiation in mitigating excess risk of cancer observed among WLWH; and 3) estimate the burden of cancer-related mortality among PLWH. This research utilized administrative health data from Population Data BC (which included data from the BC Cancer Agency and Vital Statistics) and clinical HIV data from the BC Centre for Excellence in HIV/AIDS. Findings suggest WLWH experience an increased risk of certain cancers, notably for certain viral-related malignancies, in comparison to HIV-negative women in the modern cART era. A protective effect of early initiation of cART therapy was found for some types of cancer, suggesting oncological health benefits might be associated with timely initiation of cART after HIV diagnosis for WLWH. Finally, sex stratified age-adjusted cancer-related mortality rates promisingly suggest there may not be significantly different cancer-related mortality outcomes between PLWH and the general population. This dissertation demonstrates that cancer-related morbidity is a healthcare priority for the growing aging demographic of WLWH and subsequently highlights the importance of appropriate and effective routine cancer screening measures as well as comprehensive HIV care inclusive of timely diagnosis and cART initiation.