Abstract

BackgroundAnal cancer is rare in the general population in both genders in the US, but an increased incidence of anal cáncer (AC) has been reported among people living with HIV-1 infection (PLWH) and little is known among the population in South US.MethodsIn a retrospective study design, electronic health records from 2006 to 2018 were reviewed in a HIV clinical cohort at the University of Alabama at Birmingham. Associations of demographic, sociodemographic, and HIV-clinical indicators were examined in univariate analyses between high-grade squamous intraepithelial lesions (HSIL) and AC cases and condition-free individuals. Factors for anal/rectal cytology screening tests among PLWH were also assessed over time. Ages at onset of anal cancer were compared with the general US population reported by the National Surveillance, Epidemiology, and End Results Program.ResultsA total of 79 anal HSIL (96% men) and 43 cancer (100% men) patients were observed along with 4367 HSIL/cancer-free patients (75.9% men). HSIL (P < 0.0001) and AC (0.0001 < P < 0.01) were associated with being men who have sex with men (MSM). An incidence of 258 per 100,000 person-year was observed among this clinical cohort of PLWH. PLWH who were 45–54 years appeared to be at highest risk of AC (58.1%), as compared to those 55–64 years in the general population. Overall, 79% of PLWH anal cancers were diagnosed among those under 55 years (vs 39.5% in general population) indicating early onset of AC. In total 29.1% of HSIL and 44.2% of AC patients had not received an anal/rectal cytology examination 1 year prior to diagnosis.ConclusionAC incidence among HIV-infected men was 161 times higher than general population with an earlier age of onset/diagnosis. Many patients with AC had missed screening opportunities that could potentially have captured neoplasia in pre-cancerous stages. AC-related screening guidelines need to be integrated into routine clinical care, especially among PLWH at highest risk such as MSM and those with lower CD4 counts.

Highlights

  • Anal cancer (AC) is rare in the general United States (US) population, with an estimate of 8,300 new diagnoses, 5,530 in women and 2,770 in men, reported in 2019 [1]

  • Individuals co-infected with High-risk Human Papillomavirus (HR-HPV) and Human Immunodeficiency Virus (HIV), and men who have sex with men (MSM) have been identified as major factors that increase the risk of anal cancer [6,7,8]

  • While only 26.5% of anal cáncer (AC) occurred among individuals younger than 55 years in the general population, we observed that 79% of anal cancers occurred in the same age range among people living with HIV-1 infection (PLWH) (Fig. 1)

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Summary

Introduction

Anal cancer (AC) is rare in the general United States (US) population, with an estimate of 8,300 new diagnoses, 5,530 in women and 2,770 in men, reported in 2019 [1]. The incidence of AC has been increasing over recent years in some high-risk populations [4], among people living with human immunodeficiency virus (PLWH) [5]. Individuals co-infected with High-risk Human Papillomavirus (HR-HPV) and HIV, and men who have sex with men (MSM) have been identified as major factors that increase the risk of anal cancer [6,7,8]. Anal cancer is rare in the general population in both genders in the US, but an increased incidence of anal cáncer (AC) has been reported among people living with HIV-1 infection (PLWH) and little is known among the population in South US

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