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Risk factors for anal cancer in persons infected with HIV: a nested case-control study in the Swiss HIV Cohort Study

Franceschi, Silvia
Lise, Mauro
Vernazza, Pietro
Schöni-Affolter, Franziska
Dehler, Silvia
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Published in American journal of epidemiology. 2013, vol. 178, no. 6, p. 877-84
Abstract Although persons infected with human immunodeficiency virus (HIV), particularly men who have sex with men, are at excess risk for anal cancer, it has been difficult to disentangle the influences of anal exposure to human papillomavirus (HPV) infection, immunodeficiency, and combined antiretroviral therapy. A case-control study that included 59 anal cancer cases and 295 individually matched controls was nested in the Swiss HIV Cohort Study (1988-2011). In a subset of 41 cases and 114 controls, HPV antibodies were tested. A majority of anal cancer cases (73%) were men who have sex with men. Current smoking was significantly associated with anal cancer (odds ratio (OR) = 2.59, 95% confidence interval (CI): 1.25, 5.34), as were antibodies against L1 (OR = 4.52, 95% CI: 2.00, 10.20) and E6 (OR = ∞, 95% CI: 4.64, ∞) of HPV16, as well as low CD4+ cell counts, whether measured at nadir (OR per 100-cell/μL decrease = 1.53, 95% CI: 1.18, 2.00) or at cancer diagnosis (OR per 100-cell/μL decrease = 1.24, 95% CI: 1.08, 1.42). However, the influence of CD4+ cell counts appeared to be strongest 6-7 years prior to anal cancer diagnosis (OR for <200 vs. ≥500 cells/μL = 14.0, 95% CI: 3.85, 50.9). Smoking cessation and avoidance of even moderate levels of immunosuppression appear to be important in reducing long-term anal cancer risks.
Keywords AdultAntiretroviral Therapy, Highly Active/adverse effects/statistics & numerical dataAnus Neoplasms/epidemiology/etiology/virologyCD4 Lymphocyte CountCase-Control StudiesComorbidityFemaleHIV Infections/complications/drug therapy/epidemiologyHomosexuality, Male/statistics & numerical dataHuman papillomavirus 16/isolation & purification/pathogenicityHumansImmunocompromised HostIncidenceMaleMiddle AgedPapillomavirus Infections/complications/transmission/virologyRisk FactorsSmoking/adverse effects/epidemiologySubstance Abuse, Intravenous/complicationsSwitzerland/epidemiology
PMID: 23900553
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Research groups Groupe Bouchardy Magnin Christine (Registre genevois des tumeurs) (532)
VIH/SIDA (930)
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BERTISCH, Barbara et al. Risk factors for anal cancer in persons infected with HIV: a nested case-control study in the Swiss HIV Cohort Study. In: American journal of epidemiology, 2013, vol. 178, n° 6, p. 877-84. doi: 10.1093/aje/kwt153 https://archive-ouverte.unige.ch/unige:33950

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Deposited on : 2014-01-31

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