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The Impact of HIV Viral Control on the Incidence of HIV-Associated Anal Cancer

Chiao, Elizabeth Y. MD, MPH*,†,‡; Hartman, Christine M. PhD*,†,‡; El-Serag, Hashem B. MD, MPH*,†,‡; Giordano, Thomas P. MD, MPH*,†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2013 - Volume 63 - Issue 5 - p 631–638
doi: 10.1097/QAI.0b013e3182968fa7
Epidemiology and Prevention

Background: Recent studies have shown that the incidence of squamous cell cancer of the anus (SCCA) has increased in the combined antiretroviral therapy (cART) era. The effect of undetectable HIV viral loads as a result of successful cART has not been evaluated.

Methods: We performed a retrospective cohort study among male US veterans diagnosed with HIV and followed between 1985 and 2009 using the Veterans Affairs Immunologic Case Registry (VA-ICR). We calculated age-adjusted incidence rates and rate ratios for SCCA. We conducted Cox proportional hazards ratios of SCCA in a multivariable model including time-varying covariates of nadir CD4 count and overall percentage of time with an undetectable HIV viral load.

Results: The age-adjusted SCCA incidence rate among the group who ever received cART was 146.8/100,000 person-years (95% confidence interval, 124.1 to 172.6) and was not significantly higher than the SCCA rate of those who never received cART (134.3/100,000 person-years; 95% confidence interval, 112.5 to 159.0). In a multivariable model limited to veterans who had ever received cART (adjusted for demographic variables, nadir, and most recent CD4 counts) individuals who had 61%–80% or 81%–100% of follow-up time with undetectable HIV viral loads had significantly decreased SCCA risk compared with those who had undetectable HIV viral loads <20% of the time (odds ratio, 0.56; P = 0.040 and odds ratio, 0.55; P = 0.0004, respectively).

Conclusions: HIV control as measured by the percent of time with undetectable HIV viral load seems to decrease the risk of SCCA. Optimizing cART adherence and HIV viral load control may decrease the risk of subsequent SCCA.

*Department of Medicine, Baylor College of Medicine, Houston, TX;

Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; and

Baylor College of Medicine, Department of Medicine, Houston, TX.

Correspondence to: Elizabeth Y. Chiao, MD, MPH, Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030 (e-mail:

The authors have no conflicts of interest to disclose.

Supported with resources and the use of facilities at the Houston Health Services Research and Development Center of Excellence (FP90-020), Michael E. DeBakey Veterans Affairs Medical Center, and by a seed fund grant from the Baylor College of Medicine. E.Y.C. (K23CA124318 and R01CA163103) and H.B.E.-S. (K24DK078154 and P30DK58338) received support from the National Cancer Institute.

Received January 24, 2013

Accepted April 10, 2013

© 2013 by Lippincott Williams & Wilkins