Is anal carcinoma a HAART-related problem?
BACKGROUND
There is evidence that frequency of AIN/AC rises in HIV+ individuals treated with HAART whilst frequency of most other opportunistic neoplasms declines with immune reconstitution.


METHODS
1472 patients were screened 3655 times for ACA as a strong risk factor for AIN/AC. The periods 1985 to 1995 (before introduction of PI in Germany) and 1996 to 2001 were compared. In addition, 10 cases of AC are described. Time between HIV-infection and AC as well as time between ACA and AC is assessed, pre-treatment with HAART, age, CD4-cell count and CDC-stage at timepoint of diagnosis of AC is mentioned.


RESULTS
There are significantly higher numbers of ACA+ screens in the years after 1996 (p<0.001) independent of number of CD4+ T-lymphocytes. AIN/AC occurs more often in HIV+ individuals, preferably in advanced disease stages, at younger age and within a shorter time after first signs of ACA than in HIV-negative population. AC occurs more likely in patients pretreated with HAART, AC tumor stage is ACIS in most cases. -


CONCLUSIONS
Analogical to AIN/AC, frequency of ACA seems to rise under HAART (regimen including PI) although risk for opportunistic diseases usually decreases under HAART. Similarity of AC to ICC in HIV+ women is striking and AC could become part of the list of AIDS-indicator diseases. According to pre-existing cost-effectiveness calculations [6], screening for AC (including physical examination, proctoscopy, cytology and biopsy of all suspect lesions) should be performed every 2-3 years in patients with CD4+ T-lymphocytes >500/microl and yearly in patients with CD4+ T-lymphocytes <500/microl. Existing ACA should be treated thoroughly. The role of serum HIV load in development and progression of ACA [20], and in consequence of AIN/AC needs further investigation.
Horster
Sophia
S
Mediziniscche Poliklinik, Ludwig-Maximilians-Universität, Munich, Germany. sophiahorster@gmx.de
Thoma-Greber
E
E
Siebeck
M
M
Bogner
J R
JR
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001004:Anus Diseases / Q000150:complications; D001005:Anus Neoplasms / Q000209:etiology*; D002278:Carcinoma in Situ / Q000209:etiology; D003218:Condylomata Acuminata / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012307:Risk Factors