Review
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 7, 2011; 17(25): 2987-2991
Published online Jul 7, 2011. doi: 10.3748/wjg.v17.i25.2987
Squamous cell carcinoma of the anus-an opportunistic cancer in HIV-positive male homosexuals
Pascal Gervaz, Alexandra Calmy, Ymer Durmishi, Abdelkarim S Allal, Philippe Morel
Pascal Gervaz, Ymer Durmishi, Philippe Morel, Department of Surgery, Geneva University Hospital and Medical School, 1211 Genève, Switzerland
Alexandra Calmy, Departments of Infectious Diseases, Geneva University Hospital and Medical School, 1211 Genève, Switzerland
Abdelkarim S Allal, Department of Radiation Oncology, Hopital Cantonal de Fribourg, 1211 Genève, Switzerland
Author contributions: Durmishi Y and Calmy A performed the literature search and critically reviewed published data; Allal AS revised the manuscript and designed the research; Gervaz P and Morel P wrote the manuscript.
Correspondence to: Pascal Gervaz, MD, Department of Surgery, Geneva University Hospital and Medical School, 4 rue Gabrielle-Perret-Gentil, 1211 Genève, Switzerland. pascal.gervaz@hcuge.ch
Telephone: +4122-372-7703 Fax: +4122-372-7707
Received: October 20, 2010
Revised: December 10, 2010
Accepted: December 17, 2010
Published online: July 7, 2011
Abstract

Squamous cell carcinoma of the anus (SCCA) is a common cancer in the human immunodeficiency virus (HIV)-infected population, and its incidence continues to increase in male homosexuals. Combined chemoradiation with mitomycin C and 5-fluorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy (HAART), however, recent data indicate that: (1) most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and (2) this approach is associated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recurrence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in middle-aged HIV-positive male homosexuals. In this population, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses (HPVs). Large-scale cancer-prevention strategies (routine anuscopy and anal papanicolaou testing) should be implemented in this population. In addition, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.

Keywords: Anal cancer; Chemoradiation; Highly active antiretroviral therapy; Human immunodeficiency virus; Human papillomaviruse; Outcome