In:
Diseases of the Colon & Rectum, Ovid Technologies (Wolters Kluwer Health)
Abstract:
People living with human immunodeficiency virus have an increased risk of anal cancer. OBJECTIVE: The aim of this study is to estimate anal cancer incidence and related risk factors in a national cohort of HIV-infected patients. DESIGN: Prospective multicentric cohort study. SETTINGS: Multicentric study including patients from the Spanish HIV Research Network. PATIENTS: We collected data from 16,274 HIV-infected treatment-naïve adults, recruited from January 2004 to November 2020. MAIN OUTCOMES MEASURES: The primary outcome measures of this study were incidence and prevalence of anal carcinoma. Secondary outcome measures included the associations between baseline and time-dependent covariables and the primary endpoint. RESULTS: Twenty-six cases of anal cancer were diagnosed, 22 of which were incident cases resulting in a cumulative incidence of 22.29/100,000 persons-year which was stable over the study period. At the end of the study, 20 of the 43 centers had screening programs for high-grade anal dysplasia. Patients with anal cancer were males (26/26; 100% vs 13,833/16,248; 85.1%), mostly men who have sex with men (23/26; 88.5% vs 10,017/16,248; 61.6%), with a median age of 43 years (IQR: 35 – 51), 34.6% (9/26) 〈 35 years, more frequently previously diagnosed with an AIDS-defining illness (9/26; 34.6% vs 2429/16248; 15%) and had lower nadir CD4 cell counts (115 µL vs 303 µL). In multivariable analysis, men who have sex with men and patients with prior AIDS-defining illness had an 8.3-fold (95%CI: 1.9 – 36.3) and 2.7-fold (95%CI: 1.1 – 6.6) increased hazard ratio for developing anal cancer, respectively. Patients with higher CD4 cell counts during the follow-up showed a 28% lower risk per each additional 100 CD4 cell/µL (95% CI: 41%– 22%). LIMITATIONS: Lack of information on some potential risk factors, screening and treatment of high-grade anal dysplasia were not uniformly initiated across centers during the study period. CONCLUSIONS: While the overall incidence in our study was low, there was a significant number of patients 〈 35 years old with anal cancer. In addition to age, other factors such as men who have sex with men and patients with severe immunosuppression (current or past) should be prioritized for anal cancer screening.
Type of Medium:
Online Resource
ISSN:
0012-3706
DOI:
10.1097/DCR.0000000000002940
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2023
detail.hit.zdb_id:
2046914-7
