From the Guidelines
Yes, you should check for HIV in a patient with squamous cell carcinoma (SCC) of the anus. HIV testing is recommended as part of the standard workup for all patients diagnosed with anal SCC, as stated in the NCCN guidelines 1. This is because HIV infection is a significant risk factor for anal cancer, with HIV-positive individuals having a higher risk of developing this malignancy compared to the general population. The testing should include a standard HIV antibody/antigen combination test, with confirmatory testing if the initial screen is positive. Knowing a patient's HIV status is crucial for treatment planning, as it may influence surgical approaches, radiation tolerance, and chemotherapy dosing, as well as the need for coordination with HIV specialists to optimize antiretroviral therapy 1. Some key points to consider in the workup and treatment of anal cancer in patients with HIV include:
- The use of normal tissue-sparing radiation techniques
- The consideration of nonmalignant causes for lymphadenopathy
- The need for more frequent posttreatment surveillance anoscopy for PLWH
- The potential for poor performance status in PLWH, which may be related to HIV, cancer, or other causes, and should be considered when making treatment decisions 1. Overall, the most recent and highest quality evidence supports HIV testing as a crucial part of the standard workup for patients with anal SCC, in order to inform treatment decisions and optimize patient outcomes 1.
From the Research
Association between HIV and Anal Squamous Cell Carcinoma
- There is a notable association between HIV infection and the development of anal squamous cell carcinoma (SCC) 2, 3, 4.
- Studies have shown that HIV-positive individuals, particularly those with AIDS, have a higher incidence of anal SCC compared to the general population 2, 5.
- The increased risk is thought to be related to the immunosuppressive effects of HIV, which may allow human papillomavirus (HPV) to persist and progress to cancer 3, 5.
Screening for HIV in Patients with Anal SCC
- Given the strong association between HIV and anal SCC, it is reasonable to consider screening for HIV in patients diagnosed with anal SCC 2, 3.
- Screening for HIV may help identify individuals who are at higher risk for other HIV-related complications and allow for earlier initiation of antiretroviral therapy 6.
- However, there is currently no consensus on routine screening for HIV in patients with anal SCC, and more research is needed to determine the efficacy and cost-effectiveness of such screening 3.
Clinical Characteristics and Outcomes
- HIV-positive patients with anal SCC often present with more advanced disease and poorer outcomes compared to HIV-negative patients 2, 4.
- CD4 count and viral load are important prognostic factors, with lower CD4 counts and higher viral loads associated with poorer outcomes 2, 6.
- Highly active antiretroviral therapy (HAART) has been shown to improve outcomes in HIV-positive patients with anal SCC, and its initiation before treatment for anal SCC may decrease toxicity and improve survival 2, 6.