title: Anal Squamous Cell Carcinoma in African Americans with and without HIV: A Comparative Study.
abstract: BACKGROUND
  The incidence of anal carcinoma has increased over the last few decades especially in African Americans (AA) despite the use of highly active anti-retroviral therapy (HAART). Here, we retrospectively review oncologic outcomes of AA patients with anal squamous cell carcinoma (SCC) with and without HIV to further examine the cause of this trend.
  
  
  METHODS
  All adult AA patients diagnosed with anal SCC from 2000 to 2007 who met inclusion were examined. All patients were staged according to the American Joint Committee on Carcinoma (AJCC) sixth edition staging classification. Patients were divided into two cohorts: HIV (-) and HIV (+). Demographics, comorbidities, and oncologic outcomes were analyzed.
  
  
  RESULTS
  Twenty-two AA patients with anal SCC were analyzed. Fifteen (68.%) were HIV (+) and seven (32%) were negative. Seventy-four percent of HIV (+) patients were on HAART therapy at the time of diagnosis. The HIV (+) cohort was significantly younger, mostly male, and had more comorbidities compared to the negative cohort. There was no difference in tumor, nodal or metastasis (TNM) stage for both cohorts. HIV (+) patients were more likely to receive non-operative therapy. The 5-year survival rate for HIV negative and positive patients was 57% and 58%, respectively. AJCC stage was the only factor predictive of survival after performing Cox hazard proportional regression analysis, HR: 1.96 (95% CI, 0.987 to 3.881).
  
  
  CONCLUSIONS
  In the HAART era, HIV (+) AA patients are at high risk of developing anal SCC. However, the prognosis of HIV (+) AA with anal SSC is similar to that of their HIV (-) counterparts. Carcinoma stage is the only factor predictive of survival.
authors: Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
authors: Carl
authors: C
authors: Lokko
authors: Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
authors: Jacquelyn
authors: J
authors: Turner
authors: Biostatistics Core at R-CENTER, and Department of Community Health and Preventive Medicine, Morehouse School of Medicine.
authors: Wonsuk
authors: W
authors: Yoo
authors: Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
authors: Dorian
authors: D
authors: Wood
authors: Morehouse School of Medicine, Department of Medicine.
authors: Kyra
authors: K
authors: Clark
authors: Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
authors: Ed
authors: E
authors: Childs
authors: Cancer Biology Program, Department of OB/GYN, Morehouse School of Medicine.
authors: Veena N
authors: VN
authors: Rao
authors: Cancer Biology Program, Department of OB/GYN, Morehouse School of Medicine.
authors: E Shyam P
authors: ES
authors: Reddy
authors: Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, 720 Westview Drive SW, Atlanta, GA 30310-1495, USA.
authors: Clarence
authors: C
authors: Clark
keywords: African Americans; Anal carcinoma; HIV; Squamous cell carcinoma