HIV-associated anal cancer: has highly active antiretroviral therapy reduced the incidence or improved the outcome?

Abstract

BACKGROUND:

Highly active antiretroviral therapy (HAART) has reduced the incidence and improved the survival of patients with Kaposi sarcoma and AIDS-related non-Hodgkin lymphoma. We wished to evaluate its effects on incidence and survival in HIV-associated anal cancer.

METHODS:

We measured the incidence and survival of patients with invasive anal cancer from our prospective cohort of 8640 HIV-seropositive individuals.

RESULTS:

In our cohort of 8640 HIV-seropositive individuals, the incidence of invasive anal cancer (diagnosed in 26 patients) is 60 per 100,000 patient-years. This is 120 times higher than in the age- and gender-matched general population. The incidence of invasive anal cancer in the HIV cohort was 35 (95% confidence interval CI: 15-72) per 100,000 patient-years of follow-up in the pre-HAARTera (1984-1995) and 92 (95% CI: 52-149) per 100,000 patient-years of follow-up in the post-HAARTera (1996-2003) (P > 0.05). These figures are significantly higher than those for the general population (P < 0.001 for both) and give a relative risk of 67 and 176 in the pre- and post-HAART eras, respectively, compared with the general population. The 5-year overall survival is 47% (95% CI: 24%-70%), and the 5-year disease-free survival is 66% (95% CI: 45%-87%). There is no difference in overall survival between the pre- and post-HAART eras (log rank P = 0.19).

CONCLUSIONS:

Unlike other HIV-associated cancers, there has been no significant change in the incidence, clinical features, or overall survival since the introduction of HAART.

• Authors: Mark Bower, Tom Powles, Tom Newsom-Davis, Christina Thirlwell, Justin Stebbing, Sundihya Mandalia, Mark Nelson, Brian Gazzard
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 37 Issue 5 Pg. 1563-5 (Dec 15 2004) ISSN: 1525-4135 [Print] United States
• PMID: 15577408 (Publication Type: Journal Article)

Topics

• AIDS-Related Opportunistic Infections (epidemiology, mortality)
• Adolescent
• Adult
• Antiretroviral Therapy, Highly Active
• Anus Neoplasms (epidemiology, mortality)
• Cohort Studies
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Incidence
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Survival Analysis