A concerning trend is emerging within the HIV-positive population: a significant rise in oropharyngeal cancer, particularly among heterosexual men. New data presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) confirms that this cancer, affecting the back of the mouth and throat, is no longer rare in certain subgroups, demanding a reassessment of screening protocols and preventative strategies.
- Rising Incidence: Oropharyngeal cancer rates in people with HIV have more than doubled between 2000-2002 and 2018-2020, reaching 42.3 per 100,000 person-years.
- Gender Disparity: Men with HIV are significantly more likely to be diagnosed than women (31.4 vs. 10.9 per 100,000 PY), with heterosexual men facing the highest risk.
- HPV Persistence: The leading theory points to a greater persistence of Human Papillomavirus (HPV) in individuals with HIV, potentially exacerbated by differences in HPV transmission and immune response.
Oropharyngeal cancer, often linked to HPV-16, smoking, and alcohol consumption, typically affects the base of the tongue, soft palate, and tonsils. While approximately 60,000 Americans are diagnosed with oral or throat cancers annually, the escalating rates within the HIV-positive community represent a distinct and growing public health challenge. This isn’t simply a matter of increased lifespan due to effective HIV treatment; the incidence is rising *above* what would be expected given improved overall health. A 2025 meta-analysis by Bandala-Jacques and colleagues already highlighted this trend, showing the highest incidence rates in men living with HIV, even exceeding those of cervical cancer in women.
The North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study, analyzing data from over 135,000 people with HIV, revealed a clear correlation between immunosuppression levels and cancer risk. Interestingly, individuals with higher (but not fully restored) CD4 counts – between 200 and 499 – showed a reduced risk compared to those with severely suppressed immune systems (below 200). This suggests that while HIV treatment is crucial, the degree of immune recovery plays a significant role in HPV control and cancer prevention. The study also reinforces the known risks associated with smoking and alcohol, each increasing the likelihood of diagnosis by 30%.
The Forward Look
The findings underscore an urgent need for targeted screening programs for people with HIV, particularly heterosexual men, those with a history of smoking or alcohol use, and individuals with varying degrees of immunosuppression. However, a significant gap in the current data is the lack of information on HPV vaccination status. Given that most participants in the study entered cohorts before widespread HPV vaccination, the impact of vaccination remains unknown.
We can anticipate several key developments in the coming years. First, increased research will focus on understanding the mechanisms behind HPV persistence in people with HIV, specifically exploring the differences in viral clearance between men and women. Second, public health initiatives will likely prioritize HPV vaccination campaigns within the HIV-positive community, recognizing its potential to significantly reduce cancer incidence. Finally, and critically, healthcare providers will need to adapt clinical guidelines to incorporate regular oropharyngeal cancer screening for at-risk individuals, potentially utilizing minimally invasive techniques for early detection. The question isn’t *if* we’ll see more of these cancers, but *how quickly* we can implement preventative measures and improve outcomes through early diagnosis and treatment.
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