Spanish study finds similarly low rate of new cancers after liver transplantation in people with and without HIV
June 26, 2026
CATIE
- HIV and transplantation drugs can weaken the immune system, increasing cancer risk
- Researchers monitored people with and without HIV for up to 14 years after liver transplant
- No increased risk for the development of new cancers occurred in people with HIV
Studies have found that HIV treatment (antiretroviral therapy; ART) has had a tremendous impact on the survival of people with HIV. When used as directed, many people with HIV will have near-normal life expectancy. In most people, ART can suppress levels of HIV so low that the virus cannot be detected with routine lab tests. The suppression of HIV leads to the immune system repairing much of the injury caused by the virus.
However, complications can still occur, caused by inflammation or other coinfections. For instance, some viruses are spread in similar ways as HIV, including the following:
- hepatitis B virus (HBV)
- hepatitis C virus (HCV)
- hepatitis D virus
These viruses infect the liver, and if the infection becomes chronic, it can cause inflammation in this vital organ. If left undiagnosed and untreated, over time the functioning of the liver becomes degraded and there is an increased risk of serious complications, liver cancer and death.
There is a vaccine for HBV and there are treatments for this virus that can help control it. Although there is no vaccine for HCV, there are highly effective treatments that can cure this infection in as little as eight to 12 weeks. There is no vaccine for hepatitis D, but a treatment called Hepcludex (bulevirtide) was approved in Canada in 2025.
Organ transplants
When organs degrade significantly, sometimes transplantation is considered as an option. However, transplantation surgery is complex and there is a shortage of organs relative to the demand. For a transplanted organ or tissue to thrive, it is necessary to partially suppress the immune system of the host (the person who receives the transplant). This partial suppression is needed so that the recipient’s immune system does not treat the transplanted organ as foreign, attacking and destroying it. There is a fine balance that needs to be achieved with transplantation drugs so that the new organ survives but not at the cost of the recipient developing serious infections and a significantly increased risk of cancer.
People with HIV are increasingly being accepted for organ transplantation.
Researchers across Spain pooled health-related information collected from people with and without HIV who received a transplanted liver between 2002 and 2012 and who received continued monitoring to 2016. Researchers focused on the risk for new cases of cancer in this population.
Overall, they found that the risk of new tumours developing after transplantation was similar in people with and without HIV.
Study details
Researchers from 22 clinics in Spain pooled their data on adults with HIV who underwent liver transplantation. For purposes of comparison, researchers matched data from each person with HIV to three people without HIV who also underwent liver transplantation. Both populations were of similar age and included the same proportion of males and females. People who developed a recurrence of liver cancer or what the researchers called “non-melanoma skin cancer” were not considered.
Health-related information from two groups were used for the study: 272 people with HIV and 816 people without HIV. Despite carefully matching participants, people with HIV were slightly older (49 vs. 46 years). They were also more likely to have HBV or both HBV and HCV than people without HIV.
Most participants were cisgender males (almost 80%).
Results
In the Spanish study, the two most used medicines for suppressing the immune system after transplantation were cyclosporine and tacrolimus. The researchers found that people with HIV were more likely to get regimens based on cyclosporine, while people without HIV were more likely to get regimens based on tacrolimus.
Cancer risk
After a period of 68 months (5.5 years) the distribution of new cases of cancer was as follows:
- people with HIV – 6% (16 people)
- people without HIV – 8% (61 people)
This difference was not statistically significant.
Among people with HIV who developed a new cancer, researchers noted that at the time they entered the study, they had an average CD4+ count of 374 cells and most had an undetectable viral load.
The most common type of new cancers in most participants who developed them (regardless of HIV status) were as follows:
- non-Hodgkin lymphoma
- head and neck cancer
One person with HIV developed lung cancer compared to 13 people without HIV.
The chance of developing a new cancer after 10 years was distributed as follows:
- people with HIV – 8%
- people without HIV – 10%
This difference was not statistically significant.
Survival
Unfortunately, rates of death among people who developed new cancers were relatively high and their survival shortened. Researchers think that the poor survival was caused by late detection of cancer.
After an average of eight months, 60% of participants diagnosed with new cancers died.
The survival rates of people with cancers were distributed as follows:
Survival one year after diagnosis
- people with HIV – 53%
- people without HIV – 46%
Survival three years after diagnosis
- people with HIV – 43%
- people without HIV – 37%
Survival five years after diagnosis
- people with HIV – 43%
- people without HIV – 26%
These differences in rates of survival over time between the two study populations were not statistically significant.
Among people with HIV, lab measures such as CD4+ or CD4/CD8 ratios did not have a significant impact on the risk of cancer after transplantation. However, researchers did find that people who had higher CD8+ cell counts at the time of liver transplantation did have a subsequently increased risk for developing a new cancer.
Age is an important factor in cancer risk and survival. As the immune system ages, it gradually becomes weaker. Overall, the researchers found that for each one-year increase in age, there was a 4% increased risk of cancer. This does not mean that most people who get a liver transplant will get cancer as they age. But it does mean that the risk is heightened as they age.
Bear in mind
According to the research team, “The most important finding of this study is the confirmation that a person with HIV who [received] a liver transplant did not face an increased risk of cancer when compared to patients without HIV.”
The research team did not have access to information about alcohol and tobacco use and how these may have affected cancer risk in the study. Information on levels of transplant drugs (cyclosporine, tacrolimus) in the blood was not available, so the researchers could not consider this when examining cancer risk (for instance, if levels of these drugs were higher in people who subsequently developed cancer).
The researchers stated that as people with HIV who were in the study “had relatively well-preserved immune function, their [overall] risk of cancer may be moderate.”
As mentioned earlier, the researchers found that new cancers were diagnosed at an advanced stage in participants. This finding underscores the need for cancer screening in people who have received transplanted organs.
—Sean R. Hosein
Resources
Hepatitis C Basics – CATIE
Changes in liver scar tissue burden after hepatitis C virus cure in people with HIV —TreatmentUpdate
Large U.S. study explores risk of cancers in people with HIV– CATIE News
North American study finds low CD4/CD8 ratio can help predict cancer risk in people with HIV – CATIE News
Ontario study looks at trends in cancer in people with HIV – CATIE News
Second cancer risk after surviving Hodgkin's lymphoma in people with HIV – CATIE News
REFERENCE:
Herrero JI, Agüero F, Manzardo C, et al. De novo cancer in liver transplant patients with human immunodeficiency virus infection: A Multicenter Nationwide Cohort Study. Clinical Infectious Diseases. 2026; in press.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/spanish-study-finds-similarly-low-rate-of-new-cancers-after-liver-transplantation-in
For more information visit CATIE's Information Network at www.catie.ca
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