| Title | Anal cancers among HIV-infected persons: HAART is not slowing rising incidence. | | Author(s) | Crum-Cianflone NF, Hullsiek KH, Marconi VC, Ganesan A, Weintrob A, Barthel RV, Agan BK, the Infectious Disease Clinical Research Program HIV Working Group | | Institution | aInfectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA bInfectious Disease Clinic, Naval Medical Center San Diego, San Diego, California, USA cDivision of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA dInfectious Disease Clinic, San Antonio Military Medical Center, San Antonio, Texas, USA eInfectious Disease Clinic, National Naval Medical Center, Bethesda, Maryland, USA fInfectious Disease Clinic, Walter Reed Army Medical Center, Washington, District of Columbia, USA gInfectious Disease Clinic, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. | | Source | AIDS 2009 Nov 18. | | 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 US 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, a P value is equal to 0.02. Rates continued to increase, reaching 128 in 2006-2008. Persons with HIV infection for at least 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/mul, 74% had a nadir CD4 cell count of less than 200 cells/mul, 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 nadir CD4 cell count (hazard ratio 0.85 per 50 cells, 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 use does not appear protective of anal cancer, studies on preventive strategies are needed. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19926961 |
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