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Markers of immune function (cd4, viral load) and survival among cancer
patients with HIV in the United States:
a population-based registry linkage study
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May 29 2026
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People with human immunodeficiency virus (HIV, PWH) have an elevated incidence of certain cancers and worse survival following a cancer diagnosis compared to cancer patients without HIV.1-8 HIV is associated with reduced cancer-specific survival (i.e., a higher risk of dying from cancer), and this association persists even after accounting for the more advanced stage at diagnosis and disparities in cancer treatment seen in PWH.6, 9-13
We found that CD4 counts following a cancer diagnosis were strongly associated with survival outcomes among PWH for many of the most common cancers in this population. While it is not surprising that low CD4 counts are associated with increased overall mortality (due to deaths from AIDS) we show that low CD4 counts are also strongly associated with cancer-specific mortality.
RESULTS: Cancer-specific mortality was significantly greater for individuals with a CD4 count of 0-49 compared to 200+ cells/mm3 for NHL (HR=1.82, 95%CI=1.30-2.53), prostate cancer (HR=3.98, 95%CI=1.56-10.15), KS (HR=4.16, 95%CI=1.49-11.67), lung cancer (HR=1.69, 95%CI=1.33-2.14), colorectal cancer (HR=2.79, 95%CI=1.58-4.92), and liver cancer (HR=1.44, 95%CI=1.01-2.70). For lung cancer, those with a CD4 count of 200+ cells/mm3 had 3-year cancer-specific cumulative mortality of 52% versus 72% for those with a CD4 count of 0-49.
Conclusion
Among PWH with cancer, cancer-specific mortality increased with lower CD4 counts, including for solid tumors not associated with HIV, e.g., prostate and lung cancer. These results highlight the role of immunity in control of cancer.
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