Incidence of Cancers Among Children Living With HIV in Malawi After Widespread Availability of Antiretroviral Therapy: A Population-Based Study

Authors

• Casey L McAtee
• Fatsani Manase
• William Kamiyango
• Jimmy Villiera
• Mark Zobeck
• Joseph Mhango
• Allison Silverstein
• Samuel Maloya
• Apatsa Matatiyo
• Eluness Simwela
• Honour Mhango
• Desire Hellings
• Brigid O'Brien
• Claudia Wallrauch
• Tom Heller
• Matthew Painschab
• Kate Westmoreland
• Atupele Mpasa
• Rizine Mzikamanda
• Nmazuo Ozuah
• Joseph Lubega
• Nader Kim El-Mallawany
• Carl E Allen
• Michael E Scheurer

Language

English

Publication Date

3-1-2026

Journal

JCO Global Oncology

DOI

10.1200/GO-25-00448

PMID

41791009

PMCID

PMC12994518

PubMedCentral® Posted Date

3-6-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Purpose: Few data describe the modern epidemiology of pediatric HIV-associated cancers in sub-Saharan Africa, home to over 80% of the world's children living with HIV. This study evaluated the incidence of cancers among these children over 15 years after widespread antiretroviral therapy (ART) adoption in Malawi.

Methods: We conducted a retrospective population-based cohort study leveraging multiple independent data sources comprehensive of all cancer diagnoses among children living with HIV in Northern and Central Malawi between 2010 and 2024. HIV-associated cancers were defined as those cancers with well-established epidemiologic associations with HIV. Cumulative incidence and average annual percent change were estimated using joinpoint regression. Next, we conducted a subcohort analysis within the country's largest pediatric HIV clinic to evaluate cancer risk factors using log-binomial regression.

Results: Among 1,686 pediatric cancer diagnoses, 184 (10.9%) occurred in children with HIV. Kaposi sarcoma (KS) accounted for 96% of cases. The cumulative incidence of HIV-associated malignancies fell from 4.7 cases per million children in 2010 to 1.2 per million in 2024, representing an 84% decline from its peak in 2013 and an average annual percent decline of 13% (P < .001). KS dropped from the third- to seventh-most common childhood cancer in the region. Notably, 58% of affected children were ART-naïve at diagnosis. Initiating ART in infancy reduced the risk of KS by 69% (P < .001). Other HIV-associated cancers were rare, comprising 0.4% of all cases diagnosed.

Conclusion: National ART expansion substantially reduced pediatric HIV-associated cancers in Malawi, achieving declines comparable with those seen in high-income countries. Sustained early diagnosis and ART linkage remain essential to sustain progress.

Keywords

Humans, Malawi, HIV Infections, Female, Child, Incidence, Neoplasms, Male, Child, Preschool, Retrospective Studies, Adolescent, Infant, Risk Factors, Anti-Retroviral Agents

Published Open-Access

yes

Recommended Citation

McAtee, Casey L; Manase, Fatsani; Kamiyango, William; et al., "Incidence of Cancers Among Children Living With HIV in Malawi After Widespread Availability of Antiretroviral Therapy: A Population-Based Study" (2026). Faculty, Staff and Students Publications. 7032.
https://digitalcommons.library.tmc.edu/baylor_docs/7032