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Dramatic increase in the incidence of anal cancer despite HAART in the French hospital database of HIV
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Reported by Jules Levin
XVI Intl AIDS Conference, Toronto, Aug 2006
Piketty C.1, Selinger-Leneman H.2, Grabar S.3, Duvivier C.4, Bonmarchand M.4, Abramowitz L.5, Costagliola D.2, Mary-Krause M.2
1Hopital Europeen Georges Pompidou and Univ Paris 5, Department of Immunology, Paris, France, 2INSERM U720 and Univ Pierre et Marie Curie, Paris, France, 3INSERM U720 and Hopital Cochin, Paris, France, 4Hopital Pitie Salpetriere, Paris, France, 5Hopital Bichat-Claude Bernard, Paris, France
ABSTRACT
Background: Recent studies suggest that HAART exhibited no effect on the incidence of anal HPV infection and anal SIL precursors of anal cancer. There is limited data on the impact of HAART on the incidence of anal cancer among HIV-infected patients.
Methods: We recorded and validated the cases of anal cancer diagnosed between 1992 and 2003 in the French Database of HIV (FHDH) that included 74,446 HIV-infected patients. Incidence rates of anal cancer among 3 different time periods were compared: 1992-march1996 (pre-HAART period), April 1996-1998 (early HAART period), 1999-2003 (recent HAART period).
Results:
We identified 92 cases of anal squamous cell carcinoma:
84 in men (90%) and
8 in women.
Among men, 74% were men who have sex with men.
The median age at diagnosis was 42.4 years (IQR: 36.0-49.3).
The median CD4 cell count was 247.5 cells/mm3 (IQR: 135-420).
The median nadir CD4 cell count was 80 cells/mm3 (IQR: 21-174) and
39% of the cases had presented an AIDS defining event prior to the anal cancer diagnosis.
At diagnosis, 71 patients (77%) were receiving HAART with a median duration of 65 months (IQR: 44-77).
CHANGES in the anal cancer incidence from 1992-1996 through 1999-2003 time periods:
--There were 9 cases during 1992-96 (Relative Risk: 1), 12 from 1996-98 (RR: 1.36), and 69 during 1999-2003 (RR: 3.93).
--Among MSM there were 6 cases during 1992-96 (RR: 1), 10 during 1996-1998 (RR: 1.71), and 44 during 1999-2003 (RR: 3.83).
The authors concluded:
Incidence of anal cancer among HIV-infected patients has increased since 1999. Although some ascertainment bias cannot be excluded, the data indicate that HAART exhibited no favorable effect on the incidence of anal cancer and support the urgent need for developing anal cancer screening programs for HIV-infected individuals, whether untreated or under HAART. This increase in incidence may be attributed to patients living longer and subsequently developing diseases that were seen less commonly prior to combination ARV therapy.
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