{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:47:23Z","timestamp":1782265643354,"version":"3.54.5"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Despite widespread antiretroviral therapy (ART) use, whether the expected transition from AIDS-defining to non-AIDS-defining cancers has occurred in settings with persistent late HIV presentation remains unclear. We examined long-term cancer patterns, determinants, and survival outcomes in a large HIV cohort. Methods: This retrospective, single-center cohort included 1419 people living with HIV followed between 2006 and 2024. Patients who developed malignancy were classified as AIDS-defining cancers (ADC) or non-AIDS-defining cancers (NADC). Immuno-virological parameters were assessed at HIV and cancer diagnosis. Survival was analyzed using Kaplan\u2013Meier methods, and predictors of mortality were evaluated using Cox proportional hazards regression. Determinants of ADC development were assessed using multivariable logistic regression. Temporal changes were evaluated by trend analysis. Results: Sixty-six patients (4.6%) developed malignancy (31 ADC, 35 NADC). Late HIV presentation was common, with 72.7% having CD4+ T-lymphocyte counts &lt; 350 cells\/mm3 at cancer diagnosis, particularly among ADC cases. Most ADCs (93.5%) occurred within 24 months of HIV diagnosis. Overall survival did not differ between ADC and NADC groups (log-rank p = 0.14). Although mortality declined after 2015, temporal changes in ADC and NADC proportions did not reach statistical significance (p = 0.14). In Cox regression analysis, viral suppression before death or last follow-up was independently associated with lower mortality risk (HR 0.12; 95% CI 0.05\u20130.31). Lower CD4+ T-lymphocyte counts were associated with ADC development, and a CD4+ T-lymphocyte threshold of 295 cells\/mm3 showed good discriminative performance (AUC = 0.83), although this cutoff should be interpreted cautiously due to the lack of external validation. Conclusions: In this long-term cohort from T\u00fcrkiye, a clear epidemiological transition from ADC to NADC could not be demonstrated. The cancer spectrum remained strongly influenced by late HIV presentation and advanced immunodeficiency. Sustained viral suppression was independently associated with lower mortality risk, supporting the importance of early HIV diagnosis, timely ART initiation, and sustained virological control.<\/jats:p>","DOI":"10.3390\/jcm15124818","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:03:23Z","timestamp":1782263003000},"page":"4818","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Has the Expected Shift in HIV-Related Cancers Occurred? Findings from a Long-Term HIV Cohort in Turkey"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2987-1534","authenticated-orcid":false,"given":"\u0130nci","family":"Y\u0131lmaz Nakir","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, \u0130stanbul 34270, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-230X","authenticated-orcid":false,"given":"Melike Nur","family":"\u00d6z\u00e7elik","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Namik Kemal University, Tekirdag 59100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8985-0559","authenticated-orcid":false,"given":"Rumeysa G\u00fclistan","family":"Karaduman","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, \u0130stanbul 34270, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7023-6639","authenticated-orcid":false,"given":"Esra","family":"Zerdali","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, \u0130stanbul 34270, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"ref_1","unstructured":"UNAIDS (2025). AIDS, Crisis and the Power to Transform: UNAIDS Global AIDS Update 2025, Joint United Nations Programme on HIV\/AIDS."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1097\/COH.0000000000000304","article-title":"Survival in individuals living with HIV","volume":"11","author":"Costagliola","year":"2016","journal-title":"Curr. Opin. HIV AIDS"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1093\/cid\/cix998","article-title":"Multimorbidity among persons living with human immunodeficiency virus in the United States","volume":"66","author":"Wong","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","unstructured":"European Centre for Disease Prevention and Control, and World Health Organization Regional Office for Europe (2025). HIV\/AIDS Surveillance in Europe 2025: 2024 Data, ECDC."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1097\/QAD.0b013e3283319184","article-title":"HIV infection and the risk of cancers with and without a known infectious cause","volume":"23","author":"Silverberg","year":"2009","journal-title":"AIDS"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0140-6736(07)61050-2","article-title":"Incidence of cancers in people with HIV\/AIDS compared with immunosuppressed transplant recipients: A meta-analysis","volume":"370","author":"Grulich","year":"2007","journal-title":"Lancet"},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm. Rep., 41, 1\u201319."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7588928","DOI":"10.1155\/2024\/7588928","article-title":"The trends and risk factors of AIDS-defining cancers and non\u2013AIDS-defining cancers in adults living with and without HIV: A narrative review","volume":"2024","author":"Mathoma","year":"2024","journal-title":"J. Cancer Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jamaoncol.2025.1589","article-title":"Cancer incidence and trends in US adults with HIV","volume":"11","author":"Haas","year":"2025","journal-title":"JAMA Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1002\/ijc.35493","article-title":"Cancer incidence in people with HIV in Italy: Comparison of the ICONA cohort with general population data","volume":"157","author":"Muccini","year":"2025","journal-title":"Int. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.26719\/emhj.19.030","article-title":"Prevalence and mortality of cancer among people living with HIV and AIDS patients: A large cohort study in Turkey","volume":"26","author":"Aydin","year":"2020","journal-title":"East. Mediterr. Health J."},{"key":"ref_12","first-page":"36","article-title":"The changing face of HIV-associated malignancies: Advances, opportunities, and future directions","volume":"39","author":"Lurain","year":"2019","journal-title":"ASCO Educ. Book"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/apm.13020","article-title":"Cancer during HIV infection","volume":"128","author":"Brites","year":"2020","journal-title":"APMIS"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/QAI.0000000000003389","article-title":"Nationwide longitudinal annual survey of HIV\/AIDS referral hospitals in Japan from 1999 to 2021: Trend in non\u2013AIDS-defining cancers among individuals infected with HIV-1","volume":"96","author":"Tanaka","year":"2024","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1566","DOI":"10.1016\/S2214-109X(23)00349-2","article-title":"Global patterns and trends in Kaposi sarcoma incidence: A population-based study","volume":"11","author":"Fu","year":"2023","journal-title":"Lancet Glob. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"209","DOI":"10.5501\/wjv.v4.i3.209","article-title":"Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era","volume":"4","author":"Brugnaro","year":"2015","journal-title":"World J. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/QAD.0000000000000922","article-title":"Prevalence of non-HIV cancer risk factors in persons living with HIV\/AIDS: A meta-analysis","volume":"30","author":"Park","year":"2016","journal-title":"AIDS"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102661","DOI":"10.1016\/j.jiph.2025.102661","article-title":"Malignancies in people living with HIV: A 25-year observational study from a tertiary hospital in Italy","volume":"18","author":"Anastasia","year":"2025","journal-title":"J. Infect. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1093\/cid\/ciad671","article-title":"Measures of longitudinal immune dysfunction and risk of AIDS and non\u2013AIDS-defining malignancies in antiretroviral-treated people with, HIV","volume":"78","author":"Chammartin","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e338","DOI":"10.1093\/cid\/ciaf248","article-title":"Risk of cancer in people with HIV experiencing varying degrees of immune recovery with sustained virological suppression on antiretroviral treatment","volume":"81","author":"Han","year":"2025","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13027-018-0188-3","article-title":"Survival after cancer diagnosis in a cohort of HIV-positive individuals in Latin America","volume":"13","author":"Fink","year":"2018","journal-title":"Infect. Agents Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, J.S., Cole, S.R., Achenbach, C.J., Dittmer, D.P., Richardson, D.B., Miller, W.C., Mathews, C., Althoff, K.N., Moore, R.D., and Eron, J.J. (2018). Cancer risk in HIV patients with incomplete viral suppression after initiation of antiretroviral therapy. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197665"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.3346\/jkms.2017.32.9.1445","article-title":"Trends in malignancies among Korean patients infected with human immunodeficiency virus in the HAART era","volume":"32","author":"Lee","year":"2017","journal-title":"J. Korean Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4818\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:27:59Z","timestamp":1782264479000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,21]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124818"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124818","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,21]]}}}