title: HAART slows progression to anal cancer in HIV-infected MSM.
abstract: OBJECTIVE
  Antiretrovirals do not prevent anal intraepithelial neoplasia. However, the influence of antiretrovirals in the natural history of invasive anal cancer is less clear. The objective is to investigate the impact of antiretrovirals in the time to the development of anal cancer in HIV-positive MSM.
  
  
  METHODS
  A retrospective analysis of cases of anal cancer in a cohort of HIV-positive MSM receiving antiretrovirals between 1988 and 2008.
  
  
  METHODS
  Time from first CD4 cell count or HIV RNA viral load test to anal cancer diagnosis was analysed using Cox regression and Kaplan-Meier curves. Anal cancer cases treated in the era prior to HAART (<1996) were compared with those treated later (1996-2008).
  
  
  RESULTS
  Anal cancer cases (n = 37) were compared with a cohort of 1654 HIV-positive MSM on antiretrovirals. Antiretrovirals were started in the pre-HAART era by 70% of cancer cases, and median CD4 cell count nadir was 70 cells/μl (10-130). Time to development of anal cancer was shorter for cases treated during the pre-HAART era [adjusted hazard ratio (AHR) 3.04, 95% confidence interval (95% CI) 1.48-6.24, P = 0.002], with a CD4 cell count nadir less than 100 cells/μl (AHR 2.21, 95% CI 1.06-4.62, P = 0.035) and longer duration of CD4 cell count less than 100 cells/μl (AHR 1.33, 95% CI 1.11-1.58, P = 0.002).
  
  
  CONCLUSIONS
  Results show that severe immunosuppression and starting therapy pre-HAART are associated with an increased risk of anal cancer. HIV-positive MSM initiating antiretrovirals during the HAART era (1996-2008) had a longer time to the development of anal cancer than those treated pre-HAART. Our results suggest that early use of HAART may delay progression to anal cancer.
authors: aBritish Columbia Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia bBritish Columbia Centre for Excellence in HIV/AIDS cDepartment of Surgery, St. Paul's Hospital dBritish Columbia Centre for Excellence in HIV/AIDS, Division of AIDS, University of British Columbia eBritish Columbia Cancer Agency, Vancouver fBritish Columbia Centre for Excellence in HIV/AIDS, Faculty of Health Sciences, Simon Fraser University, Burnaby gDivision of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Katrina C
authors: KC
authors: Duncan
authors: Keith J
authors: KJ
authors: Chan
authors: Connie G
authors: CG
authors: Chiu
authors: Julio S G
authors: JS
authors: Montaner
authors: Andy J
authors: AJ
authors: Coldman
authors: Angela
authors: A
authors: Cescon
authors: Christopher G
authors: CG
authors: Au-Yeung
authors: Sam M
authors: SM
authors: Wiseman
authors: Robert S
authors: RS
authors: Hogg
authors: Natasha M
authors: NM
authors: Press
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000276:immunology / Q000517:prevention & control*; D015331:Cohort Studies; D004198:Disease Susceptibility; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents