The influence of HIV status on the duration of chemoradiotherapy for anal squamous cell carcinoma

Background: The HIV epidemic has changed the demographic of patients with anal squamous cell carcinoma. The influence of HIV status on the ability to complete standard chemoradiotherapy was studied. Methods: A retrospective analytic observational study was conducted of all patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital radiation oncology department with anal squamous cell carcinoma from January 2014 to December 2016. Standard chemoradiotherapy was offered to all patients. Stage of anal squamous cell carcinoma, HIV status and cluster of differentiation 4 (CD4) levels were measured and compared in groups. We considered a maximum of 42 days as complete therapy without delay. Results: Ninety-two patients with anal squamous cell carcinoma were identified, of whom 67 were seen with the intention to treat and had known HIV status, of whom 59 received chemoradiotherapy. Eighty-eight per cent were people living with HIV (PLWH). PLWH were younger (p < 0.001) and less likely to receive full-dose chemotherapy (63%, p = 0.41). No patients presented in stage 1. More than 60% presented in stage 3. Fifty-six per cent of PLWH and 57% of HIV negative patients were able to complete the 50 Gy radiation in 42 days (p = 1.0). CD4 above 200 did not impact therapy (p = 0.71). Conclusion: HIV status of anal squamous cell carcinoma has minimal impact on the duration of chemoradiotherapy.