Advances in HIV treatments have resulted in life expectancies among people with HIV (PWH) that are similar to people without HIV (non-PWH), provided that PWH have access to these treatments. As a result of increased survival times, diagnosis of non-AIDS-defining cancers, including anal cancer (AC), has increased among PWH. The purpose of this meta-analysis was to determine if PWH have a higher hazard of mortality compared to non-PWH following AC diagnosis in the post-highly active antiretroviral therapy (HAART) era. We searched PubMed, Embase, Web of Science, and conference abstracts from Jan 1, 1996 - October 31, 2018. Our analysis included longitudinal studies of adults diagnosed with AC which measured a hazard ratio (HR) of overall or cancer-specific mortality comparing PWH versus non-PWH. Using a random-effects model, we estimated the primary outcome, pooled overall survival HR, and the secondary outcome, cancer-specific survival HR. Study quality was assessed using the Newcastle-Ottawa Scale. Thirteen studies were relevant for inclusion, twelve of which had a low risk of bias. Meta-analysis of the studies reporting an overall survival HR found a non-significant pooled HR of 1.11 (95% CI: 0.85-1.44). Meta-analysis of the six studies reporting cancer-specific survival HR found a non-significant pooled HR of 1.15 (95% CI: 0.69-1.93). Heterogeneity was low and medium, respectively. Overall survival and cancer-specific survival HRs indicate that although PWH had higher mortality than non-PWH, the effects were not statistically significant. There is therefore no significant overall survival nor cancer-specific survival differences between PWH and non-PWH in the era of modern treatment.
Keywords: Anal cancer; HIV; Hazard ratio; Meta-analysis; Survival.
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