Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study

Gypsyamber D'Souza, Dorothy J. Wiley, Xiuhong Li, Joan S. Chmiel, Joseph B. Margolick, Ross D. Cranston, Lisa P. Jacobson

Research output: Contribution to journalArticlepeer-review

243 Scopus citations


OBJECTIVE:: To examine the incidence and risk factors for anal cancer in a multicenter cohort of human immunodeficiency virus (HIV) positive and HIV-negative men who have sex with men followed between 1984 and 2006 (Multicenter AIDS Cohort Study). METHODS:: Prospective analysis using Poisson regression and Cox proportional hazard models and a nested case-control study using conditional logistic regression. RESULTS:: There were 28 cases of anal cancer among the 6972 men who were evaluated. The incidence rate was significantly higher in HIV-positive men than in HIV-negative men (incidence rate = 69 vs 14 per 100,000 person-years). Among HIV-positive men, anal cancer incidence was higher in the highly active antiretroviral therapy (HAART) era than the pre-HAART era (incidence rate = 137 vs 30 per 100,000 person-years). In multivariate analysis restricted to the HAART era, anal cancer risk increased significantly with HIV infection (relative hazard = 4.7, 95% confidence interval = 1.3 to 17) and increasing number of unprotected receptive anal sex partners at the first 3 study visits (P trend = 0.03). Among HIV-positive men, current HAART use did not decrease anal cancer risk. CONCLUSIONS:: HIV-positive men had increased risk of anal cancer. Improved survival of HIV-positive individuals after HAART initiation may allow for sufficient time for human papillomavirus-associated anal dysplasias to develop into malignancies, thus explaining the increased incidence of anal cancer in the HAART era.

Original languageEnglish (US)
Pages (from-to)491-499
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number4
StatePublished - Aug 1 2008


  • Anal
  • Cancer
  • Incidence
  • MACS
  • Rectal
  • Sexual risk

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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