Cancer Pathog Ther. 2026 Mar 2;4(5):393-401. doi: 10.1016/j.cpt.2026.02.003. eCollection 2026 Sep.
ABSTRACT
BACKGROUND: The extended survival of people living with human immunodeficiency virus (HIV) (PLWH) has shifted cancer burdens toward urological malignancies. PLWH exhibit unique clinical patterns, including a younger age at diagnosis for renal cell carcinoma and more advanced stage at presentation of prostate and bladder cancers, which are compounded by inequities in health care access and HIV-specific mechanisms such as chronic immunosuppression.
METHODS: A systematic search was conducted across five databases (Web of Science, PubMed, Cochrane Library, Embase, and Scopus) up to 1 July, 2025. Random-effects models were used to pool hazard ratios (HRs) and adjusted hazard ratios (aHRs). Publication bias was assessed using Egger’s test, and sensitivity analyses were performed.
RESULTS: Nine studies with 6,615,444 participants were included. The risk factors for mortality such as kidney cancer (aHR = 1.74; 95% confidence interval [CI]: 1.11-2.75), prostate cancer (HR = 1.77; 95% CI: 1.60-1.96; aHR = 2.27; 95% CI: 1.77-2.90), and bladder cancer (aHR = 4.29; 95% CI: 1.08-17.03) were significantly higher for PLWH. The pooled unadjusted HR for kidney cancer was 1.66 (95% CI: 0.83-3.30), which did not reach statistical significance. Subgroup analyses for prostate cancer confirmed a consistent increase in mortality risk across different mortality types and follow-up durations.
CONCLUSION: HIV infection is significantly associated with increased mortality among patients with prostate cancer. For kidney cancer, limited data suggest an adverse prognostic role of HIV. For bladder cancer, the evidence remains preliminary but highlights the urgent need for dedicated investigations. These findings highlight the need to integrate urological cancer screening and tailored management into long-term HIV care. Future multicenter studies will be essential to strengthen the evidence, particularly for kidney and bladder cancers, and to clarify the roles of HIV-specific factors, tumor biology, and social determinants of health in optimizing precision medicine for this population.
PMID:42643168 | PMC:PMC13503073 | DOI:10.1016/j.cpt.2026.02.003
