Anal cancer: Focus on HIV-positive patients in the HAART-era

Anal cancer represents an increasing health problem, especially inimmune-compromised patients, as HIV-positive patients. Notably, a significanthigher incidence rate is reported among HIV infected patients with the advent of highly active antiretroviral therapy (HAART). To date, no randomised trialsupports the correlation between existing screening strategies and reducedprogression of anal intraepithelial neoplasia (AIN) to anal cancer or improvedsurvival. Nevertheless, screening and treatment of AIN by topical agents shouldbe implemented in high risk population. Data on invasive anal cancer treatmentshow that combined modality treatment (CMT) is the treatment of choice. Earlyreports on HIV-positive patients describe higher treatment toxicity and arelation with lower CD4 count and higher HIV viral load. More recently, reported outcomes seem to be similar in HIV-positive population and general population.Reports on a rise in local recurrence rates and in acute side effects along with a correlation with pre-treatment CD4 counts in HIV-positive patients, are notconfirmed by all authors. The development of the first approved vaccine is amilestone in the field of anogenital cancers. However, many questions are stillunresolved especially as concerns immunization in the setting of HIV infection.