Anal carcinoma in HIV-infected patients in the era of antiretroviral therapy: a comparative study.

BACKGROUND

Before the introduction of highly active antiretroviral therapy, prognosis of anal squamous-cell carcinoma was worse when patients were infected with HIV. Since then, contradictory results have been reported.

OBJECTIVE

To compare the results of chemoradiotherapy in HIV-infected and uninfected patients with anal carcinoma.

DESIGN

Retrospective analysis of medical records.

SETTING

Tertiary care center in France.

PATIENTS

Patients with invasive anal carcinoma treated from 2001 through 2006.

INTERVENTIONS

Chemoradiotherapy included 60 Gy pelvic irradiation and cisplatin-based chemotherapy. Surgery was performed for local failures or complications.

MAIN OUTCOME MEASURES

Tolerance for chemoradiotherapy, tumor control, and survival were evaluated.

RESULTS

A total of 46 patients (20 HIV-infected and 26 uninfected) were treated for nonmetastatic anal carcinoma. Median follow-up was 32.5 (range, 7-84) months. HIV-infected patients were more likely to be men (95% vs 23%, P < .001) and were younger (median age, 46 vs 62 years, P < .001) than uninfected patients. The viral load was less than 200 copies/mL in 15 (75%) of the HIV-infected patients. The duration of chemoradiotherapy was longer in HIV-infected than in uninfected patients (median, 103 vs 84 days, P = .027). Chemoradiotherapy failed to achieve local control in 10 (50%) HIV-infected and in 6 (23%) uninfected patients (P = .057). In HIV-infected patients, failure rates were higher in patients who required prolonged chemoradiotherapy than in those who received treatment as scheduled (7/11, 64% vs 1/7, 14%; P = .039). During follow-up, 7 (35%) of the HIV-infected and 3 (12%) of the uninfected patients died, all from anal carcinoma. The 5-year overall survival rate was 39% for HIV-infected and 84% for uninfected patients (P = .026); 5-year disease-free survival was 37% in HIV-infected and 75% in uninfected patients (P = .06).

LIMITATIONS

Retrospective design, lack of data regarding precise toxicity grading, and use of cisplatin-based chemoradiotherapy.

CONCLUSIONS

Even in the era of highly active antiretroviral therapy, HIV-infected patients with anal squamous-cell carcinoma show impaired tolerance to chemoradiotherapy, have a lower survival rate, and may have a higher rate of local failure compared with uninfected patients.