CD4+ AND SULFONYL HAART IMPACT IN ANAL CARCINOMA OUTCOMES IN PATIENTS LIVING WITH HIV

Background: Despite the rarity of anal cancer, its incidence is up 30 times higher in HIV-infected patients. Recent studies hypothesize that sulfonyl might have anti-tumor activity. In addition, some Highly Active Antiretroviral Therapies (HAART) contain sulfonyl/sulfonamide, possibly impacting oncologic outcomes in HIV+ patients. Objective: To evaluate the impact of CD4 count and HAART containing sulfonyl on the outcomes of localized anal cancer treated with standard QT/RDT. Methods: Retrospective cohort study. We reviewed electronic medical records between Aug2010 – Apr2022 and included HIV+ patients with stage I-III anal cancer in HAART therapy. We evaluated CD4+ count and HAART group (sulfonyl/sulfonamide (S) and non-sulfonyl/sulfonamide (NS)) before starting standard QT/RDT. Categorical variables were compared using Fisher’s exact test, while survival analyses were estimated with the Kaplan-Meier method. Cox regression was used for prognostic factors. Results: Fifty-seven HIV+ patients with anal cancer were included. Among 53 patients with information about the HAART regimen, 23 (43%) used the S, and 30 (57%) used NS. All patients received chemoradiation; most had stage III disease (n=39; 68%) and CD4 levels>200 (n=43; 75%). Radiologic complete response rates (CRR) at 6 months were 75% in the S group and 60% in NS (p=0.161). With a median follow-up of 34 months, 3-year RFS and OS 52.6% (95% CI 29.5-71.3%) and 80.1% (95% CI 54.9-92.2%) in S group compared to 52.6% (95% CI 33.3-68.7%) and 58.8% (95% CI 37.7-74.9%), respectively, in NS group. In a multivariable model, S group and the CD4 level were not associated with RFS (S vs SN: HR 1.00, 95% CI 0.43-2.35, P=0.983; CD4 > 200 vs ≤ 200: HR 0.81, 95% CI 0.31-2.10, P=0.671) or OS RFS (S vs SN: HR 0.62, 95% CI 0.21-1.77, P=0.376; CD4 > 200 vs ≤ 200: HR 0.78, 95% CI 0.26-2.28, p=0.653). Conclusion: All patients received optimal oncologic treatment with chemoradiation and despite provocative numerical differences encountered in the S group, no statistically significant difference was observed regarding CRR, RFS, or OS according to sulfonyl/sulfonamides or the CD4 level. Large studies are necessary to establish HAART impact in oncologic anal cancer outcomes.