Anal cancers among HIV-infected persons: HAART is not slowing rising incidence.

Abstract

OBJECTIVE:

To evaluate the incidence rates of anal cancer over the HIV epidemic and assess the impact of HAART use on anal cancer events.

METHODS:

We evaluated the incidence of and factors associated with anal cancer using longitudinal data from the prospective U.S. Military Natural History Study (1985-2008). Poisson regression and Cox proportional hazard models were utilized.

RESULTS:

Among 4506 HIV-infected men with 37 806 person-years of follow-up, anal cancer rates (per 100 000 person-years) increased five-fold, from 11 in the pre-HAART to 55 in the HAART era (P = 0.02). Rates continued to increase, reaching 128 in 2006-2008. Persons with HIV infection for more than 15 years had a 12-fold higher rate than those with less than 5 years (348 vs. 28, P < 0.01). At cancer diagnosis (n = 19), median age was 42 years, median CD4 cell count was 432 cells/microl, 74% had a CD4 nadir cell count less than 200 cells/microl, 42% had a prior AIDS event, and 74% had received HAART. From separate models, prior AIDS event (hazard ratio 3.88, P = 0.01) and lower CD4 nadir (hazard ratio 0.85 per 50 cell, P = 0.03) were associated with anal cancer, with a trend for a history of gonorrhea (hazard ratio 2.43, P = 0.07). Duration of HAART use was not associated with a reduced risk of anal cancer (hazard ratio 0.94, P = 0.42).

CONCLUSION:

Incidence rates of anal cancer have progressively increased during the HIV epidemic. Persons with a longer duration of HIV infection have a substantially higher rate of anal cancer. As HIV-infected persons are experiencing longer life expectancies and HAART does not appear protective of anal cancer, studies on preventive strategies are needed.

• Authors: Nancy F Crum-Cianflone, Katherine Huppler Hullsiek, Vincent C Marconi, Anuradha Ganesan, Amy Weintrob, Robert V Barthel, Brian K Agan, Infectious Disease Clinical Research Program HIV Working Group
• Journal: AIDS (London, England) (AIDS) Vol. 24 Issue 4 Pg. 535-43 (Feb 20 2010) ISSN: 1473-5571 [Electronic] England
• PMID: 19926961 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Topics

• Adult
• Antiretroviral Therapy, Highly Active (methods)
• Anus Neoplasms (drug therapy, epidemiology, etiology)
• CD4 Lymphocyte Count
• Carcinoma, Squamous Cell (drug therapy, epidemiology, etiology)
• HIV Infections (complications, drug therapy)
• HIV-1
• Homosexuality, Male
• Humans
• Incidence
• Male
• Middle Aged
• Military Personnel (statistics & numerical data)
• Proportional Hazards Models
• Prospective Studies
• Sentinel Surveillance
• United States (epidemiology)