The association between penile cancer and HIV infection: A literature review

Abstract

Penile cancer is a rare malignancy which HIV infection appears to increase the risk of. The magnitude of this risk and the pathogenesis remain unclear. A comprehensive review of the literature was undertaken using conventional search strategies. Twenty-four publications were identified by this methodology, of which nine were case reports and 15 were observational studies. These studies were highly heterogeneous, with varying study designs, populations, and objectives. The risk of penile cancer within HIV-positive individuals is significantly greater than in those without HIV (RR = 3 .7 to 5.8, 3 studies; SIR = 3.8 to 11.1, 4 studies). HIV is also shown to influence disease characteristics, with a four-fold increased risk of death from penile cancer. Moreover, progression from intraepithelial neoplasia occurs earlier in HIV, six years sooner than in HIV-negative men. HIV-positive men have a higher prevalence of HPV infection. Ethnicity is also shown to modulate the relationship between HIV and penile carcinoma, with a higher risk of cancer in Hispanic, compared with Caucasian, HIV-positive men. This review has collated data from diverse sources to improve understanding of the relationship between HIV and penile cancer. This relationship has been quantitatively and qualitatively characterised and highlights areas deserving further enquiry.

Epidemiology, Diagnosis and Management of Penile Cancer: Results from the Spanish National Registry of Penile Cancer

“…Furthermore, there's a faster progression from intraepithelial neoplasia to cancer (i.e., six years sooner) and increased cancer-specific mortality (i.e., four times higher). In addition, this review highlighted how coinfection by HPV is more frequent in this specific population, furtherly increasing the chance of developing penile cancer [18]. As estimated by Nunez et al [19], up to 18% (95% CI 14.3-22.1%) of patients affected by HIV are unaware of it, regardless of being men who have sex with men (MSM) or heterosexuals.…”

The effects of HIV and oncogenic human papillomavirus on the tumor immune microenvironment of penile squamous cell carcinoma

“…Both HIV and hrHPV infections are associated with an increased risk of penile cancer development [ 6 , 10 , 20 , 21 ]. These infections may also have an effect on the penile cancer tumor microenvironment, which may affect prognosis and may require a different approach in use of immune therapy.…”

“…Some previous studies and case reports have reported that HIV infection is associated with a higher risk of progression from in-situ to invasive penile cancer [ 10 , 23 ]. In our study, there was no significant difference in the proportion of HIV positive individuals between those with advanced histological stage and those with early-stage disease.…”

“…In addition, most patients in SSA present with advanced disease, and a majority are infected with the Human Immunodeficiency Virus (HIV) [ 9 ]. HIV infection has been observed to shorten the progression time from in-situ carcinoma to invasive carcinoma, with an increased risk of death from the cancer [ 10 ]. These factors are thought to contribute to the observed poor prognosis for PSCC patients in both developed and developing countries [ 11 , 12 ].…”