{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:00:12Z","timestamp":1790341212657,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","funder":[{"DOI":"10.13039\/100000016","name":"US Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA006516-50S4"],"award-info":[{"award-number":["P30CA006516-50S4"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA236546"],"award-info":[{"award-number":["R01CA236546"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["UG1CA275416"],"award-info":[{"award-number":["UG1CA275416"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI091434"],"award-info":[{"award-number":["K23AI091434"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People with human immunodeficiency virus (HIV) (PWH) experience substantially increased risk of anogenital cancer. Whether long-term antiretroviral therapy (ART) reduces anogenital cancer risk is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A target trial emulation using a case-cohort design among Botswana adults aged 30\u201365, sampled via a probability-based household survey across 30 communities. Cases of cervical, vulvar, anal, and penile cancer were prospectively ascertained at the country's principal treatment centers. We estimated the marginal relative risk (RR) of incident anogenital cancer by ART duration, compared with adults without HIV, using g-computation from weighted models that accounted for shared determinants of human papillomavirus, and HIV infection, access to cancer care, and ART duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>14 312 participants were enrolled (42% PWH), including 1045 (79% PWH) with incident anogenital cancer\u2014792 cervical, 106 vulvar, 80 anal, and 67 penile cancers. Compared with people without HIV, the marginal RR (95% CI) of anogenital cancer increased with longer durations of ART (P = .001) (no ART: 4.6; 4.3\u20135.0; &amp;lt;5 years: 4.0; 3.7\u20134.3; 5\u20139 years: 4.6; 4.2\u20135.0; \u226510 years: 7.4; 6.8\u20138.1). Individuals receiving ART for \u226510 years had the highest RR for each cancer evaluated: cervix, 4.4 (4.0 to 4.8); vulva, 36 (22\u201357); anus, 15 (11\u201320); and penis, 102 (42\u2013250). Prior advanced HIV disease was associated with increased risk but this effect diminished on ART and contributed relatively little to overall risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term utilization of ART was not associated with a reduction in anogenital cancer risk. Improved prevention strategies are needed for PWH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag501","type":"journal-article","created":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T11:32:57Z","timestamp":1787484777000},"source":"Crossref","is-referenced-by-count":0,"title":["Long-term Antiretroviral Therapy and Anogenital Cancer Risk"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0409-1769","authenticated-orcid":false,"given":"Maanasa","family":"Mendu","sequence":"first","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Internal Medicine, Yale School of Medicine , New Haven, Connecticut ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taolo","family":"Ndloedibe","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9925-1286","authenticated-orcid":false,"given":"Memory","family":"Bvochora-Nsingo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Gaborone Private Hospital , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9800-1455","authenticated-orcid":false,"given":"Sebathu","family":"Chiyapo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sir Ketumile Masire Teaching Hospital , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kutlo","family":"Manyake","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0202-7031","authenticated-orcid":false,"given":"Isaac","family":"Nkele","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9624-8366","authenticated-orcid":false,"given":"Doreen","family":"Ramogola-Masire","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Obstetrics and Gynecology, University of Botswana , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-6958","authenticated-orcid":false,"given":"Eric A","family":"Engels","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8390-6091","authenticated-orcid":false,"given":"Meredith","family":"Shiels","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1975-8837","authenticated-orcid":false,"given":"Rebecca","family":"Luckett","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1527-9046","authenticated-orcid":false,"given":"Tendani","family":"Gaolathe","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Internal Medicine, University of Botswana , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0017-2438","authenticated-orcid":false,"given":"Joseph","family":"Makhema","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Radiation Oncology, Gaborone Private Hospital , Gaborone ,","place":["Botswana"]},{"name":"Department of Internal Medicine, University of Botswana , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6401-3722","authenticated-orcid":false,"given":"Peter","family":"Vuylsteke","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Department of Internal Medicine, University of Botswana , Gaborone ,","place":["Botswana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-9716","authenticated-orcid":false,"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership , Gaborone ,","place":["Botswana"]},{"name":"Division of Infectious Disease, Brigham and Women's Hospital , Boston, Massachusetts 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