Background: Recent studies suggest that cART exhibited no effect on the incidence of invasive anal cancer. There is limited data on the impact of prolonged cART on anal cancer among HIV-infected patients. Methods: We recorded and validated the cases of anal cancer diagnosed between 1992 and 2008 in the French Database on HIV that included 109771 HIV-infected patients. Incidence rates of anal cancer among 4 different time periods were compared: 1992-1996 (pre-cART period), 1997-2000 (early cART period), 2001-2004 and 2005-2008 (recent cART period). For comparison to non HIV-infected subjects, standardized incidence ratio (SIR) was calculated for each period using the data from FRANCIM (French Network of Cancer Registries). Results: We identified 263 cases of invasive anal squamous cell carcinoma, 240 in men (91%) and 23 in women. Among men, 72% were men who have sex with men (MSM). The median age at diagnosis was 45 years (IQR: 39-50); the median CD4 cell count was 310 cells/mm3 (195-509); the median nadir CD4 cell count was 95 cells/mm3 (I21-176) and 51% of the cases had presented an AIDS defining event prior to the anal cancer diagnosis. At diagnosis, 235 patients (89%) were receiving cART with a median duration of 65 months (26-105). Changes in the anal cancer incidence rate in HIV infected patients and SIR are presented in the Table. Conclusion: The data indicate that cART exhibited no favorable effect on the incidence of anal cancer particularly in MSM and support the urgent need for developing anal cancer screening programs and treatment of squamous intraepithelial lesions.
6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011), Rome, 17 - 20 July 2011
Auteur : Piketty C, Selinger Leneman H, Grabar S, Bouvier AM, Belot A, Duvivier C, Bonmarchand M, Abramowitz L, Costagliola D, Mary Krause M
Année de publication : 2011