Identifying risk factors for anal cancer in people with HIV in Spain: a multicentre retrospective cohort study nested in the PISCIS cohort
Por:
Llibre, JM, Revollo, B, Aceiton, J, Díaz, Y, Domingo, P, Burgos, J, Sorni, P, Saumoy, M, Knobel, H, Navarro, M, Leon, E, Orti, A, Arbonés, L, Mera, A, Deig, E, Sirera, G, Miró, JM, Casabona, J and Martin-Iguacel, R
Publicada:
1 sep 2024
Ahead of Print:
1 ago 2024
Resumen:
Background People with HIV have a substantially higher risk of anal cancer than the general population. We aimed to identify risk factors associated with the development of anal cancer among people with HIV to implement more effective and targeted screening strategies.
Methods We conducted a multicentre retrospective cohort study in 16 hospitals across Catalonia and the Balearic Islands, Spain, between Jan 1, 1998, and Dec 31, 2022. Treatment-naive people with HIV nested in the PISCIS cohort aged 16 years and older with biopsy-proven squamous cell carcinoma of the anus or anal canal were eligible for inclusion. Data were retrieved from every hospital registry and were centrally validated in the PISCIS cohort and the Public Data Analysis for Health Research and Innovation Program. The primary outcome was the incidence rate (IR) of histologically confirmed anal cancer. We used Poisson regression to examine the association between the following risk factors and incidence of anal cancer: age, mode of HIV transmission, nadir CD4 cell count, and time period of HIV diagnosis.
Findings Among 14 238 people with HIV, 107 (0 center dot 8%) developed anal cancer, with an overall IR of 72 center dot 5 cases per 100 000 person-years (95% CI 59 center dot 4-87 center dot 6) and median follow-up of 9 center dot 5 years (IQR 4 center dot 4-15 center dot 7). Of these patients with anal cancer, 37 (34 center dot 6%) died, of which 24 (64 center dot 9%) deaths were related to anal cancer. Incidence was highest among people with HIV with historical nadir CD4 counts of less than 200 cells per mu L (IR 105 center dot 0 person-years, 95% CI 82 center dot 0-132 center dot 5) and lowest among those with counts of more than 350 cells per mu L (2 center dot 9 person-years, 0 center dot 1-16 center dot 0). Among men who have sex with men (MSM), the IR was 211 center dot 5 person-years (95% CI 151 center dot 1-211 center dot 7) among those with a CD4 count of less than 200 cells per mu L, 37 center dot 6 person-years (16 center dot 2-74 center dot 1) among those with a count of 200-350 cells per mu L, and 4 center dot 8 person-years (0 center dot 1-26 center dot 9) among those with a count of more than 350 cells per mu L. Among people with HIV younger than 30 years, there were no cases of anal cancer among women or men who do not have sex with men, and one case among MSM with a nadir CD4 count of more than 350 cells per mu L (IR 4 center dot 8 person-years, 95% CI 0 center dot 1-26 center dot 9). In the multivariable analysis, people with HIV with nadir CD4 counts of more than 350 cells per mu L had the lowest risk of developing anal cancer, compared with people with HIV with counts of less than 200 cells per mu L (adjusted IR ratio 0 center dot 03, 95% CI 0 center dot 00-0 center dot 25; p=0 center dot 0010) or 200-350 cells per mu L (0 center dot 30, 0 center dot 17-0 center dot 55; p<0 center dot 0001). Compared with people with HIV younger than 30 years, people with HIV aged 60 years and older had an adjusted IR ratio of 27 center dot 6 (3 center dot 7-206 center dot 9; p=0 center dot 0010) and people with HIV aged 45-59 years of 21 center dot 6 (3 center dot 0-156 center dot 4; p=0 center dot 0020). Compared with individuals diagnosed after 2015, a diagnosis of HIV before 1998 had an adjusted IR ratio of 33 center dot 0 (7 center dot 9-137 center dot 5; p<0 center dot 0001).
Interpretation A nadir CD4 count threshold below 350 cells per mu L, particularly less than 200 cells per mu L, has the potential to identify people with HIV at heightened risk of developing anal cancer. Customised screening strategies that prioritise screening for individuals at high risk with this surrogate marker could maximise available resources. External validation of these data with other cohorts is required before screening recommendations can be updated. Copyright (c) 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.
Filiaciones:
:
Univ Hosp Germans Trias, Infect Dis Div, Barcelona 08916, Spain
Fight Infect Fdn, Barcelona, Spain
Revollo, B:
Univ Hosp Germans Trias, Infect Dis Div, Barcelona 08916, Spain
Fight Infect Fdn, Barcelona, Spain
Aceiton, J:
Generalitat Catalunya, Ctr Epidemiol Studies HIV AIDS & STI Catalonia, Hlth Dept, Barcelona, Spain
Díaz, Y:
Generalitat Catalunya, Ctr Epidemiol Studies HIV AIDS & STI Catalonia, Hlth Dept, Barcelona, Spain
Domingo, P:
Santa Creu & St Pau Hosp, HIV Unit, Barcelona, Spain
Burgos, J:
Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Infect Dis, Barcelona, Spain
Sorni, P:
Son Llatzer Hosp, Dept Internal Med, Palma De Mallorca, Spain
Saumoy, M:
Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, HIV & STD Unit, Barcelona, Spain
Knobel, H:
Hosp del Mar Parc Salut MAR, Dept Infect Dis, Barcelona, Spain
Univ Pompeu Fabra, Dept Med & Life Sci, Barcelona, Spain
Inst Hlth Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas, Madrid, Spain
Navarro, M:
Parc Tauli Hosp Univ, Infect Dis Dept, Sabadell, Spain
Leon, E:
Hosp Moises Broggi, Dept Internal Med, Sant Joan Despi, Spain
Orti, A:
Verge Cinta Hosp, Dept Internal Med, Tortosa, Spain
Arbonés, L:
Consorci Sanitari Maresme, Dept Internal Med, Mataro, Spain
Mera, A:
Hosp Palamos, Dept Internal Med, Girona, Spain
Deig, E:
Hosp Gen Granollers, Dept Internal Med, Barcelona, Spain
:
Univ Hosp Germans Trias, Infect Dis Div, Barcelona 08916, Spain
Fight Infect Fdn, Barcelona, Spain
Miró, JM:
Inst Hlth Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas, Madrid, Spain
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi i Sunyer, Infect Dis Serv, Barcelona, Spain
:
Generalitat Catalunya, Ctr Epidemiol Studies HIV AIDS & STI Catalonia, Hlth Dept, Barcelona, Spain
Martin-Iguacel, R:
Generalitat Catalunya, Ctr Epidemiol Studies HIV AIDS & STI Catalonia, Hlth Dept, Barcelona, Spain
Odense Univ Hosp, Dept Infect Dis, Odense, Denmark
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