Prevalence of HIV associated cancer amongst individuals of African descent.

Abstract

Background: In sub-Saharan Africa, HIV and cancer represent a critical syndemic; however, detailed epidemiological data amongst individuals who have both conditions remain limited. The widespread rollout of antiretroviral therapy (ART) has shifted the cancer profile among people living with HIV (PLWH) from AIDS -defining cancers to non -AIDS -defining cancers. Yet, the dual burden of HIV and cancer in high-prevalence regions, such as KwaZulu-Natal (KZN), South Africa, is not well characterised. This study attempts to understand this gap in knowledge by (i) estimating the prevalence of HIV infection among cancer patients in KZN; (ii) describing the demographic profile of HIV-positive cancer patients; and (iii) identifying cancer types most strongly associated with HIV status. Methods and Materials: A nested cross-sectional study was conducted using clinical data from 1,541 adult cancer patients of African descent enrolled in an ongoing Cancer Genetics Study at a tertiary hospital in Durban, KZN, between June 2024 and June 2025. Various clinical demographic characteristics, such as HIV status, ART status, and cancer diagnosis, were extracted. Descriptive statistics and logistic regression models were used to assess associations between HIV and cancer. Results: The overall prevalence of HIV among cancer patients was 34.8% compared to the national average of 17.2%. All HIV-positive individuals were receiving ART at the time of cancer diagnosis. HIV prevalence was notably higher among female patients (41.2%), Black African individuals (44.7%), and those aged 39–48 years (59.6%). AIDS-defining cancers (ADCs) accounted for 55.4% of all malignancies, while non-AIDS-defining cancers (NADCs) comprised 29.1%. Among specific cancer types, the highest HIV prevalence was observed in vulval cancer (93.2%), anal cancer (72.2%), and cervical cancer (57.1%). Univariable logistic regression analysis revealed significantly increased odds of HIV infection among patients with vulval cancer (odds ratio (OR) 25.97; 95% confidence interval (CI) 7.21–127.40; p<0.001), anal cancer (OR 4.94; 95% CI 1.43–19.32; p=0.0148), and cervical cancer (OR 2.53; 95% CI 1.16–5.84; p=0.0224). A significant negative association was observed for leukaemia (OR 0.28; 95% CI 0.12–0.69; p=0.0042), while breast cancer showed no significant association (OR 1.08; 95% CI 0.50–2.48; p=0.8566). Conclusion: This study demonstrates a high prevalence of HIV among cancer-positive patients in KwaZulu-Natal, with varied correlation between HIV and certain cancer types, particularly Human Papillomavirus (HPV)-related malignancies, despite universal ART coverage. The distinct epidemiological profile supports the need for integrated public health strategies, including targeted cancer screening and HPV vaccination within HIV care programmes.