The long-term cancer risk following TB disease in people with HIV remains unclear. We aimed to assess cancer risk following TB in a nationwide cohort of people with HIV in Denmark.MethodsWe conducted a population-based cohort study including all individuals enrolled in the Danish HIV Cohort Study from 1995–2020. TB and cancer diagnoses were identified through nationwide registries. Incidence rates (IRs) and adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for time-varying CD4 count, age, sex, and Charlson Comorbidity Index (CCI). Additionally, we calculated aIRRs stratified by age-group, sex, CCI and CD4-count.ResultsAmong 6,135 people with HIV (median age: 37.1 years, 74.1% male), 319 had a TB diagnosis. During 62,878 person-years of follow-up (PYFU), 451 cancers were observed, including 55 lung cancers. The overall cancer IR among people with HIV without previous TB disease was 18.6 per 1,000 PYFU (95%confidence interval: 16.9–20.4), and 19.0 per 1,000 PYFU (95%CI: 10.4–25.6) among people with HIV following TB (aIRR: 1.1, 95%CI: 0.7–1.8). For lung cancer, the aIRR after TB was 1.7 (95%CI: 0.5–5.5). In stratified analyses, aIRRs were slightly higher among women (1.3, 95%CI: 0.6–2.9) and those aged ≥50 years (1.4, 95%CI: 0.8–2.4).ConclusionIn this nationwide cohort of more than 6,000 people with HIV followed for up to 25 years, we observed no increased risk of cancer following TB disease. These findings do not support changes to continued standardized cancer surveillance in people with HIV and TB.

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