Paper
Length of human immunodeficiency virus disease and not immune status is a risk factor for development of anal carcinoma

Presented at the 29th Annual Surgical Symposium of the Association of VA Surgeons, Salt Lake City, Utah, March 11–13, 2005
https://doi.org/10.1016/j.amjsurg.2005.07.011Get rights and content

Abstract

Background

The anal epithelium is subject to dysplastic change in patients with human immunodeficiency virus (HIV). We sought to determine if the duration of HIV disease or the patient’s immune status were associated with the development of anal carcinoma.

Methods

HIV-positive patients diagnosed with anal neoplasms were reviewed. Statistical analysis was performed via an unpaired Student t test and the Fisher exact test.

Results

Fourteen patients were identified, 7 with anal intraepithelial neoplasms (group 1) and 7 with anal carcinoma (group 2). Human papillomavirus was detected in 100% of patients in group 1 and in 67% of patients in group 2. There was no significant difference in the level of immunosuppression as assessed by the CD4 counts (266.9 ± 48.5 vs. 274.7 ± 92.0 cell/cμl; P = .94) and viral loads (19,243 ± 18,034 vs. 67,140 ± 39,570 RNA/mL; P = .29) between groups 1 and 2, respectively. Group 2 had been HIV positive for a significantly longer period of time (12.6 ± 2.3 y) compared with group 1 (5.9 ± 2.0 y, P = .05).

Conclusions

The most significant factor for the development of invasive anal carcinoma in patients with HIV is duration of disease. As a result of improved long-term survival secondary to new HIV therapy, anal invasive carcinoma will become an increasing problem.

Section snippets

Materials and Methods

With approval from the Baylor College of Medicine Institutional Review Board, the records of all HIV-positive patients who were diagnosed with either AINs (group 1) or anal carcinoma (group 2) between January 1998 and November 2004 at the Michael E. DeBakey Veterans Affairs Medical Center, a 420-bed tertiary care hospital serving southeast Texas, were evaluated retrospectively. The diagnosis of AIN, HPV infection, or anal carcinoma was established by surgical biopsy examination. For each

Results

From January 1998 to November 2004 there were 14 HIV/acquired immune deficiency syndrome patients with anal neoplasms evaluated by the surgery service. Seven of these patients were diagnosed with AIN (group I) and 7 patients were diagnosed with anal carcinoma (group 2). The main characteristics of these patients are shown in Table 1. All patients underwent surgical biopsy examination for diagnosis of anal neoplasm and all were symptomatic at time of presentation (Table 2).

Histologically

Comments

Anal carcinoma is a rare malignancy, accounting for only 3,400 cases per year in the United States [11]. In the HIV-positive population, however, the incidence of anal carcinoma is increasing rapidly [4], [5], [6]. Anal carcinoma is one of only a handful of cancers known to be associated with an infectious agent (HPV) [12].

Fenger and Nielsen [13], [14] described the precursor lesion to anal carcinoma, AIN, in 1981. In 1986, Frazer et al [15] observed a high incidence of AIN in HIV-positive men

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