Photoprotection and skin cancer awareness in kidney transplant recipients living with HIV: A single-centre cross-sectional study

Abstract

Background Immunosuppression medication is an important risk factor for skin cancer in kidney transplant recipients (KTR). Both HIV-associated immunodeficiency and immunosuppression required for kidney transplantation increase skin cancer rates. Kidney transplant recipients living with HIV (KTRLHIV) must take steps to minimize their risk of skin cancer through prevention. Objectives To conduct a cross-sectional study to investigate photoprotection knowledge and practices, and skin cancer awareness in KTRLHIV compared with a matched cohort of HIV-negative KTR. Methods Our study, conducted at a tertiary UK HIV kidney transplantation centre, utilized a validated sun photoprotection and skin cancer awareness questionnaire either online or in person. The KTRLHIV cohort (n = 27) and HIV-negative KTR cohort (n = 25) were matched for age, sex, ethnicity and years since transplant. Results Only 60% of KTRLHIV had been seen by a dermatologist, compared with 81% in the matched KTR cohort. Sun protection advice was received by 52% of KTRLHIV, significantly lower than the 80% in the matched cohort (P = 0.03), primarily sourced from nephrologists or dermatologists. KTRLHIV exhibited lower overall sunscreen use (33% vs. 60%, P = 0.05), fewer daily users (22% vs. 27%), lower utilization of sun protection factor > 25 (78% vs. 100%) and lower use on all exposed areas (67% vs. 87%). Sun protection behaviours were also suboptimal in KTRLHIV compared with the matched cohort, with regard to avoiding direct sun exposure (P = 0.003), and dressing to protect from the sun (P < 0.001). Conclusion Our findings reveal lower rates of skin cancer protection advice for KTRLHIV compared with matched HIV-negative KTR, likely translating into decreased sunscreen use and suboptimal sun protection behaviours. Addressing this disparity through skin cancer prevention, self-skin examination education and improved dermatology referrals is necessary.