ORLANDOA French study is the first to quantify the
frequency of anal cancer in HIV patients, Iradj Sobhani, MD,
said at the Digestive Disease Week meeting. Anal carcinoma is
rare in the general population, but relatively common in HIV-positive
patients, said Dr. Sobhani, of the Gastroenterology Service,
Hopital Bichat, Paris.
The study involved 170 patients presenting with anal condylomata
between April 1993 and April 1998110 who were HIV positive and
60 who were HIV negative. Human papillomavirus induces anal
condylomata, benign tumors that are often (more than 80% of the time)
precursors to anal cancers. In all patients, the condylomata were
The researchers then monitored the patients at 3-month intervals for
periods ranging from 6 to 63 months. The median follow-up at the time
of the report was 26 months. The researchers noted any condylomata
relapses (which were again treated) and characterized any
intraepi-thelial dysplasia or squamous neoplasia. At each visit, the
patients CD4 lymphocytes and HIV viral load were measured.
The relapse rate for condylomata was much higher in HIV-positive
patients than in those without the virus (75% in HIV-positive
patients vs 8.6% in HIV-negative patients, P = .0001).
The research revealed three independent risk factors for dysplasia:
Being HIV positive, which increased the risk of developing dysplasia
10 times; dysplasia in the first tissue screening, which raised the
risk 4.8 times; and condylomata relapse, which raised the risk 5.5
Dr. Sobhani speculated about the mechanisms underlying anal
carcinoma. HIV may damage the tissue immunity or it may
facilitate condylomata relapse and high-grade dysplasia, he
said. To reduce the risk, you have to control the
multiplication of the HIV.