Anal cancer in people living with HIV: 36 years' experience of a Greek reference center.

Abstract

This retrospective study examines the incidence and characteristics of anal cancer among people living with HIV over a 36-year period at a Greek reference center. A total of 3,105 patients followed at the Special Infectious Diseases Unit of "Andreas Sygros" Hospital were evaluated for demographic and clinical data, including CD4 counts and outcomes. Thirty-one cases of anal cancer were identified, predominantly among males (29/31). The mean age at diagnosis was 48.81 years, and CD4 counts were low at diagnosis (mean 378.6 cells/mm³). 14 patients died from anal cancer, 4 from other causes, 10 remain under follow-up, and 3 were lost to follow-up. These findings highlight that people with HIV, especially those with low CD4 counts, face an increased risk of anal cancer even with effective antiretroviral therapy. Persistent HPV co-infection exacerbates this risk. Regular screening, early detection, and preventive measures such as vaccination and behavioral interventions are essential to reduce disease burden and mortality. Psychosocial factors - including HIV-related stigma, anal sex stigma, and limited social support - may also affect healthcare engagement and willingness for anal cancer screening. Addressing these factors alongside medical interventions is crucial for prevention and early diagnosis.