title: Chemoradiotherapy for anal cancer in HIV patients causes prolonged CD4 cell count suppression.
abstract: BACKGROUND
  Despite the advent of highly active antiretroviral therapy, anal cancer remains a significant health problem in human immunodeficiency virus (HIV) patients. We present the clinical features and treatment outcomes of anal cancer in 60 HIV-positive patients over a 20-year period.
  
  
  METHODS
  A prospective database of all HIV-positive individuals managed in a specialist unit since 1986 includes 11 112 patients (71 687 person-years of follow-up). Sixty patients with anal cancer were identified. Their clinicopathological and treatment details were analysed.
  
  
  RESULTS
  At anal cancer diagnosis, the mean age was 44 years (range: 28-75 years) and the median CD4 cell count was 305 mm(-3) (range: 16-1252 mm(-3)). Fifty (83%) had chemoradiotherapy (CRT). Forty-six (92%) responded, of whom 10 (22%) subsequently relapsed with locoregional (70%), metastatic disease (10%) or both (20%). The overall 5-year survival is 65% (95% confidence interval 51% to 78%). The median CD4 count fell from 289 mm(-3) before CRT to 132 mm(-3) after 3 months and to 189 mm(-3) after 1 year (P<0.05). Six patients in remission of anal cancer died of acquired immunodeficiency syndrome defining illnesses.
  
  
  CONCLUSIONS
  The management of anal cancer with CRT achieves similar outcomes as the general population. CRT is associated with significant prolonged CD4 suppression that may contribute to late deaths of patients in remission.
authors: Department of Surgery and Cancer, Imperial College London, London.
authors: M
authors: M
authors: Alfa-Wali
authors: Department of Surgery and Cancer, Imperial College London, London.
authors: T
authors: T
authors: Allen-Mersh
authors: Department of Surgery and Cancer, Imperial College London, London; Department of Surgery, Institute of Cancer Research, London.
authors: A
authors: A
authors: Antoniou
authors: Department of Clinical Oncology, Royal Marsden Hospital.
authors: D
authors: D
authors: Tait
authors: Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK.
authors: T
authors: T
authors: Newsom-Davis
authors: Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK.
authors: B
authors: B
authors: Gazzard
authors: Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK.
authors: M
authors: M
authors: Nelson
authors: Department of Surgery and Cancer, Imperial College London, London; Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK. Electronic address: m.bower@imperial.ac.uk.
authors: M
authors: M
authors: Bower
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001005:Anus Neoplasms / Q000401:mortality / Q000628:therapy* / Q000821:virology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects* / Q000528:radiation effects*; D000069287:Capecitabine; D002470:Cell Survival / Q000528:radiation effects; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003841:Deoxycytidine; D016685:Mitomycin; D000069287:Capecitabine; D005472:Fluorouracil