title: HIV-associated anal cancer: has highly active antiretroviral therapy reduced the incidence or improved the outcome?
abstract: BACKGROUND
  Highly active antiretroviral therapy (HAART) has reduced the incidence and improved the survival of patients with Kaposi sarcoma and AIDS-related non-Hodgkin lymphoma. We wished to evaluate its effects on incidence and survival in HIV-associated anal cancer.
  
  
  METHODS
  We measured the incidence and survival of patients with invasive anal cancer from our prospective cohort of 8640 HIV-seropositive individuals.
  
  
  RESULTS
  In our cohort of 8640 HIV-seropositive individuals, the incidence of invasive anal cancer (diagnosed in 26 patients) is 60 per 100,000 patient-years. This is 120 times higher than in the age- and gender-matched general population. The incidence of invasive anal cancer in the HIV cohort was 35 (95% confidence interval CI: 15-72) per 100,000 patient-years of follow-up in the pre-HAARTera (1984-1995) and 92 (95% CI: 52-149) per 100,000 patient-years of follow-up in the post-HAARTera (1996-2003) (P > 0.05). These figures are significantly higher than those for the general population (P < 0.001 for both) and give a relative risk of 67 and 176 in the pre- and post-HAART eras, respectively, compared with the general population. The 5-year overall survival is 47% (95% CI: 24%-70%), and the 5-year disease-free survival is 66% (95% CI: 45%-87%). There is no difference in overall survival between the pre- and post-HAART eras (log rank P = 0.19).
  
  
  CONCLUSIONS
  Unlike other HIV-associated cancers, there has been no significant change in the incidence, clinical features, or overall survival since the introduction of HAART.
authors.affiliation: Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom. m.bower@ic.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Tom
authors.initials: T
authors.lastname: Powles
authors.forename: Tom
authors.initials: T
authors.lastname: Newsom-Davis
authors.forename: Christina
authors.initials: C
authors.lastname: Thirlwell
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Sundihya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis