Anal cancer is rare in the general population in both genders in the US, but an increased incidence of anal cáncer (AC) has been reported among people living with HIV-1 infection (PLWH) and little is known among the population in South US. In a retrospective study design, electronic health records from 2006 to 2018 were reviewed in a HIV clinical cohort at the University of Alabama at Birmingham. Associations of demographic, sociodemographic, and HIV-clinical indicators were examined in univariate analyses between high-grade squamous intraepithelial lesions (HSIL) and AC cases and condition-free individuals. Factors for anal/rectal cytology screening tests among PLWH were also assessed over time. Ages at onset of anal cancer were compared with the general US population reported by the National Surveillance, Epidemiology, and End Results Program. A total of 79 anal HSIL (96% men) and 43 cancer (100% men) patients were observed along with 4367 HSIL/cancer-free patients (75.9% men). HSIL (P < 0.0001) and AC (0.0001 < P < 0.01) were associated with being men who have sex with men (MSM). An incidence of 258 per 100,000 person-year was observed among this clinical cohort of PLWH. PLWH who were 45–54 years appeared to be at highest risk of AC (58.1%), as compared to those 55–64 years in the general population. Overall, 79% of PLWH anal cancers were diagnosed among those under 55 years (vs 39.5% in general population) indicating early onset of AC. In total 29.1% of HSIL and 44.2% of AC patients had not received an anal/rectal cytology examination 1 year prior to diagnosis. AC incidence among HIV-infected men was 161 times higher than general population with an earlier age of onset/diagnosis. Many patients with AC had missed screening opportunities that could potentially have captured neoplasia in pre-cancerous stages. AC-related screening guidelines need to be integrated into routine clinical care, especially among PLWH at highest risk such as MSM and those with lower CD4 counts.

中文翻译：

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对美国东南部HIV-1感染者的肛门癌前病变和癌症进行的12年回顾性评估

在美国，无论男女，肛门癌在普通人群中都是罕见的，但是据报告，感染HIV-1感染者（PLWH）的肛门癌（AC）发病率增加，在美国南部的人群中知之甚少。在一项回顾性研究设计中，阿拉巴马大学伯明翰分校的一个HIV临床队列回顾了2006年至2018年的电子健康记录。在单发分析中对高级鳞状上皮内病变（HSIL）和AC病例与无病个体之间的人口统计学，社会人口统计学和HIV临床指标之间的关联进行了检查。随着时间的流逝，还评估了PLWH中肛门/直肠细胞学筛查测试的因素。将国家癌症，流行病学和最终结果计划报告的肛门癌发病年龄与美国普通人群进行比较。观察到总共79例肛门HSIL（男性为96％）和43例癌症（100％为男性）患者以及4367例HSIL /无癌患者（男性为75.9％）。HSIL（P <0.0001）和AC（0.0001 <P <0.01）与男性成年男性（MSM）相关。在该PLWH临床队列中，每100,000人年中有258例发生。与一般人群中55-64岁的人群相比，45-54岁的PLWH患AC的风险最高（58.1％）。总体而言，在55岁以下的人群中诊断出79％的PLWH肛门癌（与普通人群的39.5％相比），表明AC发病较早。在诊断前1年，总共29.1％的HSIL和44.2％的AC患者未接受肛门/直肠细胞学检查。在感染/诊断年龄较早的艾滋病毒感染男性中，AC发病率比普通人群高161倍。许多AC患者错过了可能在癌前期捕获瘤形成的筛查机会。需要将AC相关的筛查指南整合到常规临床护理中，尤其是在MSM和CD4计数较低的高危PLWH中。