Background: Pivotal studies with curative chemoradiation (CRT) in anal cancer did not include HIV-positive (HIV+) patients. HIV status impact remains unknown in this scenario.
Methods: 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.
Results: 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).
Conclusion: 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.
Keywords: CRT; HIV; anal carcinoma; chemoradiation; squamous cell carcinoma of the anus.
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