Survival among anal cancer patients with and without HIV in the United States, 2001–2019: A cohort study

Shing, Jaimie Z.; Engels, Eric A.; Austin, April A.; Clarke, Megan A.; Hayes, Jennifer H.; Kreimer, Aimée R.; Monterosso, Analise; Horner, Marie-Josèphe; Pawlish, Karen S.; Luo, Qianlai; Zhang, Elizabeth R.; Koestler, Aimee J.; Pfeiffer, Ruth M.; Shiels, Meredith S.

doi:10.1016/S2352-3018(23)00257-6

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Survival among anal cancer patients with and without HIV in the United States, 2001–2019: A cohort study

1 2024
By Shing, Jaimie Z. ; Engels, Eric A. ; Austin, April A. ; ...
Source: Lancet HIV. 11(1):e31-e41

Public Access Version Available on: January 01, 2025, 12:00 AM

Please check back on the date listed above.

English

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Alternative Title:

Lancet HIV
Personal Author:

Shing, Jaimie Z. ; Engels, Eric A. ; Austin, April A. ; Clarke, Megan A. ; Hayes, Jennifer H. ; ... More +

Shing, Jaimie Z. ; Engels, Eric A. ; Austin, April A. ; Clarke, Megan A. ; Hayes, Jennifer H. ; Kreimer, Aimée R. ; Monterosso, Analise ; Horner, Marie-Josèphe ; Pawlish, Karen S. ; Luo, Qianlai ; Zhang, Elizabeth R. ; Koestler, Aimee J. ; Pfeiffer, Ruth M. ; Shiels, Meredith S. Less -
Description:

Background:

Anal cancer risk is elevated among people with HIV (PWH), particularly in men who have sex with men with HIV. Estimating survival by HIV status and sex and identifying high-risk groups is critical for documenting prognostic differences between populations.

Methods:

We used data from linked HIV and cancer registries in the U.S. on anal cancer patients aged 20–79 diagnosed during 2001–2019. We assessed sex-specific adjusted hazard ratios (aHRs) of all-cause and anal cancer-specific mortality by HIV status using Cox proportional-hazard models, adjusting for year, age, race/ethnicity, histology, stage, region, and treatment. We identified predictors of mortality by HIV status. Models among PWH further adjusted for AIDS and HIV transmission group.

Findings:

Between 2001–2019, 43·6% (1161) of 2662 PWH with anal cancer died versus 35·4% (7722) of 21824 patients without HIV. HIV was associated with a 1·35-fold [95% confidence interval (95%CI)=1·24-1·47] increase in all-cause mortality among male patients, and a 2·47-fold (95%CI=2·10-2·90) increase among female patients. Among PWH with anal cancer, all-cause mortality was greater among non-Hispanic Black individuals (aHR=1·19, 95%CI=1·04-1·38), people with AIDS (aHR=1·36, 95%CI=1·10-1·68), people who inject drugs (PWID) (aHR=1·49, 95%CI=1·17-1·90), those with adenocarcinoma (aHR=2·74, 95%CI=1·82-4·13), and those without surgery treatment (aHR=1·34, 95%CI=1·18-1·53). HIV was associated with anal cancer-specific mortality among female patients only (aHR=1·52, 95%CI=1·18-1·97). Among PWH, anal cancer-specific mortality was greater among those with adenocarcinoma (aHR=3·29, 95%CI=1·89-5·72), those with no/unknown treatment compared to any treatment with either surgery, radiation, and/or chemotherapy (aHR=1·59, 95%CI=1·17-2·17), and among PWID (aHR=1·60, 95%CI=1·05-2·44).

Interpretation:

Among anal cancer patients, HIV was associated with all-cause mortality, with a much stronger association among female patients. Anal cancer-specific mortality was elevated among female patients with HIV. As anal cancer screening becomes more widespread, examining impacts of screening on survival by HIV status and sex is crucial.

Funding:

U.S. National Cancer Institute Intramural Research Program.
Keywords:

[+]

Acquired Immunodeficiency Syndrome Adenocarcinoma Anus Neoplasms Female HIV Infections Homosexuality, Male Humans Male Retrospective Studies Sexual And Gender Minorities Substance Abuse, Intravenous United States
Source:

Lancet HIV. 11(1):e31-e41
Pubmed ID:

38081198
Pubmed Central ID:

PMC10862232
Document Type:

Journal Article
Funding:

U58 DP003931/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201800009C/CA/NCI NIH HHSUnited States/ ; HHSN261201300019C/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; U62 PS003960/PS/NCHHSTP CDC HHSUnited States/ ; ... More +

U58 DP003931/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201800009C/CA/NCI NIH HHSUnited States/ ; HHSN261201300019C/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; U62 PS003960/PS/NCHHSTP CDC HHSUnited States/ ; Z99 CA999999/ImNIH/Intramural NIH HHSUnited States/ ; U01 DP006302/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201300021C/CA/NCI NIH HHSUnited States/ ; U62 PS001005/PS/NCHHSTP CDC HHSUnited States/ ; U62 PS004001/PS/NCHHSTP CDC HHSUnited States/ ; U01DP006302/ACL/ACL HHSUnited States/ ; U62 PS004011/PS/NCHHSTP CDC HHSUnited States/ ; HHSN261201800009I/CA/NCI NIH HHSUnited States/ ; HHSN261201800007C/CA/NCI NIH HHSUnited States/ ; HHSN261201300019I/CA/NCI NIH HHSUnited States/ Less -
Volume:

11
Issue:

1
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha-512:0598ad8cb37f530dd94694bc3a1bfa23b43a8e226e59f13d16718a925f45cdabf3d041a4dbdedb2404711fc7632c8a8ce8ef3942fc1fdf661bd73c98d6302940
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