HIV-infected people diagnosed with anal cancer, especially women, have lower survival rates after diagnosis, and survival rates for all people diagnosed with anal cancer have not improved significantly in the past 20 years, says US study announced. Lancet HIV I will report it.
Anal cancer is a rare cancer caused by oncogenic strains of human papillomavirus. The HPV vaccine that prevents cervical cancer also prevents anal cancer, but HPV is widespread among people with HIV, and living with HIV greatly increases the risk of developing anal cancer. One study found that gay and bisexual men with HIV had a 39 times higher risk of anal cancer than the rest of the U.S. population.
Like all cancers, the risk of anal cancer can increase with age. As the population of older HIV-infected individuals increases due to improved survival with antiretroviral therapy, the incidence of anal cancer is expected to increase as well. However, what is not clear is how living with HIV affects survival after anal cancer diagnosis, and how age, gender, race, and ethnicity influence survival for people with HIV. Or not.
Dr. Jamie Sing of the National Cancer Institute and colleagues at state cancer registries found that in 13 U.S. states, anal cancer among people aged 20 to 79 diagnosed with anal cancer between 2001 and 2019. The survival rate was investigated. They identified 24,486 people diagnosed with anal cancer between 2001 and 2019. study period. Of these, 2,662 were living with HIV.
People with HIV and people diagnosed with anal cancer differ in several ways. People with HIV were more likely to be male (85% vs. 33%), younger than 60 years of age (87% vs. 49%), and non-Hispanic black (37% vs. 12%) or Hispanic (21% vs. 10%). The percentage of non-Hispanics was low. -Hispanic whites (37% vs. 74%). People with HIV infection were diagnosed with non-squamous cell carcinoma more often than others (96% vs. 84%) and when the cancer was at a local stage (52% vs. 47%). Although there were no significant differences in receipt of treatment or surgery for anal cancer by HIV status, HIV-infected individuals were slightly less likely to receive chemotherapy, perhaps because they had more frequent localized cancers. You can
During the follow-up period, 43% of HIV-infected patients and 35% of other anal cancer patients died of any cause. After adjusting for confounders, all-cause mortality was 2.5 times higher in HIV-infected women compared with HIV-uninfected women and 35% higher in HIV-infected men compared with non-HIV men. Considering only deaths from anal cancer, women with HIV had a 52% higher mortality rate than men without HIV. There was no difference in mortality between HIV-infected and uninfected people.
Five-year anal cancer-specific survival was higher for HIV-infected men than for non-HIV men (80% vs. 72%), but the opposite was true for HIV-infected women (74% vs. 80%). Death rates from anal cancer were significantly higher in people diagnosed with adenocarcinoma, which occurs in cells deep within the anus near the rectum. This cancer was less common in people with HIV.
Comparing five-year survival rates for anal cancer in people with HIV by diagnosis period, researchers found that those diagnosed from 2015 to 2019 compared to those diagnosed from 2001 to 2004. found that although there was a trend towards improved survival, the risk was reduced. Mortality was not statistically significant.
Among people with HIV, all-cause and anal cancer mortality rates were significantly higher among people who acquired HIV through injecting drugs than among those who acquired HIV through sex between men and women. There were no differences in anal cancer mortality by race or ethnicity, but non-Hispanic blacks with HIV had slightly higher all-cause mortality than non-Hispanic whites (19% risk of death). it was high).
Researchers found that increasing awareness among health care professionals about the need for anal cancer screening in gay and bisexual men with HIV suggests that This may explain the difference in mortality rates. They say more data would be helpful about the impact of anal cancer screening and treatment of high-grade squamous intraepithelial lesions on anal cancer mortality.
In a second study, Dr. Cameron Haas of the National Cancer Institute and colleagues reported on the risk of death after being diagnosed with high-grade (severe) squamous intraepithelial lesions (AIN grade III). Journal of the National Cancer Institute. AIN grade III means that severe abnormal cells may be detected within the anus. It is a precursor to the development of anal cancer.
Most people diagnosed with AIN grade III do not develop anal cancer, and in some cases, AIN grade III may disappear without treatment. However, in most cases, doctors will advise treatment of AIN grade III with surgery, laser treatment, or imiquimod cream to remove the abnormal cells.
Dr. Haas and colleagues examined cancer registries in 11 U.S. states from 1996 to 2016 and found that the rate of AIN grade III increased by 14% per year among HIV-infected men, compared to 6% among HIV-uninfected men. I discovered that Analyzing the rate of change by period, AIN grade III diagnoses among men did not increase from 1996 to 2004, but increased significantly from 2005 to 2019. It increased by 15% per year among women with HIV and 6% among women with HIV. However, there was no evidence of an accelerating trend over time.
In the 5 years after diagnosis of AIN grade III, 1.3% of HIV-infected men without an AIDS diagnosis developed squamous cell carcinoma of the anus. None of the HIV-infected women who had not been diagnosed with AIDS developed anal cancer. Among those diagnosed with AIDS, 3.7% of men and 3.4% of men developed anal cancer after being diagnosed with AIN grade III.
Researchers say the increased rate of AIN grade III is likely a result of increased screening tests, and that people previously diagnosed with AIDS should be prioritized for screening.