Anal cancer impact among people with HIV infection - a matched cohort study

Pivotal studies with curative chemoradiation (CRT) in anal cancer did not include HIV-positive (HIV+) patients. HIV status impact remains unknown in this scenario.

In this retrospective matched cohort study, electronic medical records were reviewed at Sao Paulo State Cancer Institute between 2010 and 2021 patients with anal cancer T1-4 N0-1 M0 by AJCCVIII were selected. For each HIV+ patient, one or two HIV-negative (HIV-) cases were matched by age, stage (T, N) and ECOG. The primary endpoint was OS, estimated using Kaplan-Meir and compared with the log-rank test.

122 patients were selected, 45 being HIV+. The median follow-up was 37 months. Most patients, n = 119 (98%), received concomitant CRT and had ECOG 0/1 (n = 116, 95%). Stage III corresponded to 69% of the patients (n = 85). Positive nodes were detected in 76 patients (62%). No difference was observed in complete clinical response (cCR) post-CRT (68% in HIV+ versus 63% in HIV-; p = 0.6). Median recurrence-free survival (RFS) was not reached; 3-year RFS rates were 60.7% in HIV+ versus 63.1% in HIV- [hazard ratio (HR) 1.20, 95% CI 0.66-2.17, p = 0.538]. Median OS was not reached; 3-year OS was 66.4% HIV+ versus 72.2% in HIV- (HR 1.23, 95% CI 0.61-2.47, p = 0.546). HIV+ pts presented significantly more hospital admissions due to toxicity, 30% (n = 12/40) versus 13% (n = 10/74) (p = 0.049). No difference between groups was found for colostomy (p = 0.69) and salvage surgery (p = 1).

Anal carcinoma HIV+ patients treated with CRT presented similar cCR, RFS and OS compared with HIV- patients. Optimal therapy should be attempted in the HIV+ population; however, close clinical monitoring due to higher hospital admission is required.