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 24 February 2018

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News

Invasive squamous-cell carcinoma of the anal canal in HIV-infected patients, and outcomes in patients undergoing highly active antiretroviral therapy

Researchers in Germany and Texas have conducted a study investigating outcomes in patients with HIV who have also been diagnosed with invasive squamous-cell carcinoma of the anal canal.

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Writing in the August issue of the journal Diseases of the Colon & Rectum, the researchers note that in the past, prior to the development of highly active retroviral therapy for the treatment of HIV infection, HIV patients diagnosed with invasive squamous-cell carcinoma of the anal canal carried a very poor diagnosis.

This study was designed to determine the outcome in a similar group of patients in the era of highly active antiretroviral therapy.

The scientists identified HIV-positive patients treated for invasive squamous-cell carcinoma of the anal canal at the University of Texas Medical Center affiliated hospitals from 1980 to 2001. Patients were identified from operative data and cancer registries.

The records were reviewed and data was collected regarding age, CD4 count, highly active antiretroviral therapy, cancer treatment, complications, and survival.

Pre-highly active antiretroviral therapy group – all 6 patients died with active squamous-cell carcinoma
Highly active antiretroviral therapy group – 2 of 6 patients died with active squamous-cell carcinoma
Diseases of the Colon & Rectum

The patients were then divided into two groups based on the presence or absence of highly active antiretroviral therapy and compared using a Kaplan-Meier approach.

In total, 14 patients with HIV and invasive squamous-cell carcinoma of the anal canal were identified, of whom 6 were in the pre-highly active antiretroviral therapy group and 8 in the highly active antiretroviral therapy group. All were considered for treatment with chemotherapy and radiation.

In the pre-highly active antiretroviral therapy group, one patient refused therapy and 3 were unable to complete the squamous-cell carcinoma therapy as planned because of complications.

This compared to 4 of the 8 highly active antiretroviral therapy patients who were unable to complete the squamous-cell carcinoma therapy as planned.

The pre-highly active antiretroviral therapy patients had a mean age of 40 years and a mean CD4 count of 190 at the time of diagnosis.

The highly active antiretroviral therapy patients had a mean age of 44 years and a mean CD4 count of 255 at the time of diagnosis.

The 24-month survival was 17% in the pre-highly active antiretroviral therapy group and 67% in the highly active antiretroviral therapy group.

All 6 patients in the pre-highly active antiretroviral therapy group died with active squamous-cell carcinoma vs. 2 in the highly active antiretroviral therapy group.

In total, 4 of the remaining 6 patients had no evidence of active squamous-cell carcinoma at the last follow-up visit.

Commenting on their findings, the researchers said, "A review of patients with HIV and invasive squamous-cell carcinoma of the anal canal suggests a trend toward a higher CD4 count at the time of diagnosis and improved survival in patients receiving highly active antiretroviral therapy."

They added, "In this new era, HIV-positive patients should be on highly active antiretroviral therapy. If not, highly active antiretroviral therapy should be initiated, and standard multimodality therapies for invasive squamous-cell carcinoma of the anal canal are recommended."

Dis Colon Rectum 2004; 47 (8): 1305 - 1309
15 September 2004

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