title: HIV Infection Is Associated With Poor Outcomes for Patients With Anal Cancer in the Highly Active Antiretroviral Therapy Era.
abstract: BACKGROUND
  HIV status may affect outcomes after definitive chemoradiotherapy for anal cancer.
  
  
  OBJECTIVE
  Here, we report a large series in the highly active antiretroviral therapy era comparing outcomes between HIV-positive and HIV-negative patients with anal cancer.
  
  
  METHODS
  This was a retrospective chart review.
  
  
  METHODS
  The study was conducted at an outpatient oncology clinic at large academic center.
  
  
  METHODS
  A total of 107 patients were reviewed, 39 HIV positive and 68 HIV negative. All of the patients underwent definitive chemoradiation for anal cancer.
  
  
  METHODS
  Data on patient characteristics, treatment, toxicity, and outcomes were collected. Overall survival, colostomy-free survival, local recurrence-free survival, and distant metastasis-free survival were analyzed.
  
  
  RESULTS
  Median follow-up was 15 months. HIV-positive patients were younger (median, 52 vs 64 years; p < 0.001) and predominantly men (82% men vs 49% men; p = 0.001). There were no significant differences in T, N, or stage groups. HIV-positive patients had a significantly longer duration from biopsy to start of chemoradiation (mean number of days, 82 vs 54; p = 0.042). There were no differences in rates of acute toxicities including diarrhea, fatigue, or dermatitis. HIV-positive patients had significantly higher rates of hospitalization (33% vs 15%; p = 0.024). The 3-year overall survival rate was 42% in HIV-positive and 76% in HIV-negative patients (p = 0.037; HR, 2.335 (95% CI, 1.032-5.283)). Three-year colostomy-free survival was 67% in HIV-positive and 88% in HIV-negative patients (p = 0.036; HR, 3.231 (95% CI, 1.014-10.299)). Differences in overall survival rates were not significant on multivariate analysis.
  
  
  CONCLUSIONS
  This study was limited by its retrospective design and small patient numbers.
  
  
  CONCLUSIONS
  In this cohort, HIV-positive patients had significantly worse overall and colostomy-free survival rates than HIV-negative patients. However, differences in survival were not significant on multivariate analysis. Additional studies are necessary to establish the etiology of this difference.
authors.affiliation: 1 Department of Radiation Oncology, New York University Langone Medical Center, New York, New York 2 Division of Hematology and Oncology, New York University Langone Medical Center, New York, New York 3 Department of Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Grew
authors.forename: Danielle
authors.initials: D
authors.lastname: Bitterman
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Leichman
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leichman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sanfilippo
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Moore
authors.forename: Kevin
authors.initials: K
authors.lastname: Du
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001005:Anus Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016022:Case-Control Studies; D059248:Chemoradiotherapy; D003125:Colostomy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome