Despite cART, anal cancer risk still high for HIV-infected

(HealthDay)—For HIV-infected patients, despite combined antiretroviral treatment (cART), the risk of anal cancer is still much higher than in the general population, according to a study published in the Dec. 10 issue of the Journal of Clinical Oncology.

Christophe Piketty, M.D., Ph.D., from the Hôpital Européen Georges Pompidou in Paris, and colleagues compared the incidence rates of anal cancer across four time periods: 1992 to 1996 (pre-cART); 1997 to 2000 (early cART); and 2001 to 2004 and 2005 to 2008 (both recent cART). During these periods, 263 cases of histologically confirmed invasive anal squamous cell carcinoma were identified.

The researchers found that, for HIV-infected patients, the hazard ratio for anal cancer was 2.5 in the cART periods versus the pre-cART period, with no difference noted across the cART calendar periods. In 2005 to 2008, compared with the general population, for HIV-infected patients there was an excess risk of anal cancer with a standardized incidence ratio of 109.8 for men who have sex with men (MSM), 49.2 for other men, and 13.1 for women. For patients with CD4 counts above 500/µL for at least two years, the standardized incidence ratios were 67.5 and 24.5, respectively, when the CD4 nadir was less than 200/µL for more than two years or more than 200/µL.

"Relative to that in the general population, the risk of anal cancer in HIV-infected patients is still extremely high, even in patients with high current CD4 cell counts," the authors write. "cART appears to have no preventive effect on anal cancer, particularly in MSM."

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