|| Checking for direct PDF access through Ovid
Despite the advent of HAART, anal cancer remains a major healthproblem in HIV positive patients. Wepresent the outcomes of HIV positive anal cancer patients during a 20-year period from a single institution.Aprospective database identified 56 patients with HIV positive anal cancer between 1989 and 2009. Demographic, clinical and treatment data were analysed.Fifty five male and one female patient were identified, mean age of 46 years (range 28-75). Eight (14%) patients were diagnosedpre-HAART and 48 (86%) post-HAART. The median CD4 cell count was 280 mm3 (range 16-997), 48 (86%) were treated with chemoradiotherapy (CRT). Their median CD4 count fell from 305/mm3 before CRT to 132/mm3 3 months after CRT and 200/mm3 1 year after CRT (P < 0.05). 13 (27%) patients relapsed following CRT necessitating six abdomino-perineal resections with perineal reconstruction. 19 (34%) patients died: 13 from anal cancer and six from HIV related illnesses whilst in remission. The overall survival 5-year survival was 64% (95% Cl: 50-78%).HIV associated anal cancer remains common even amongst patients on HAART with relatively high CD4 counts. Management with CRT achieves similar outcomes as the general population. CRT is associated with significant andprolonged suppression of CD4.