HIV-associated colorectal cancer and the immunological effects of treatment: P084

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Aim:Since the introduction of highly active antiretroviral therapy (HAART), non-AIDS defining malignancies including colorectal cancer (CRC) have emerged as major health concerns for people living with HIV.Method:From aprospective database of 11112 HIV seropositive individuals, we identified 11 with CRC. Clinicopathological details on thepresentation, treatment and outcomes were collected.Results:All were male, median age 50 years (range 36-67) and median duration of HIV infection 7.2 years (range 0-21). Five had metastatic disease atpresentation, including one patient with a small cell cancer of the rectum. Patients were treated along conventional lines for CRC with concomitant HAART and opportunistic infectionprophylaxis. During treatment, median CD4 cell count fell from 357/mm3 at CRC diagnosis to 199/mm3, although no opportunistic infections were recorded. Three patients have died and the 5-year overall survival is 65% (95% confidence interval 32-98%).Conclusion:Treatment for CRC reduces cellular immunity and potentially puts HIV patients at risk of opportunistic infections, so knowledge of HIV statusprior to starting treatment is essential. This risk for HIV associated CRC may be reduced by concomitant HAART andprophylaxis. Clinicians managing CRC should consider screening all patients for HIV before starting chemotherapy or radiotherapy.

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