Background Anal cancer risk is elevated among people with HIV (PWH). Recent anal cancer incidence patterns among PWH in the United States (US) and Canada remain unclear. It is unknown how the incidence patterns may evolve in future years. Methods Using data from the North American AIDS Cohort Collaboration on Research and Design, we investigated absolute anal cancer incidence and incidence trends in the US, Canada, and different US regions. We further estimated relative risk compared with persons without HIV, relative risk among various subgroups, and projected future anal cancer burden among US PWH. Results During 2001-2016, in the US, age-standardized anal cancer incidence declined 2.2%/year (95%CI=-4.4% to -0.1%), particularly in the Western region (-3.8%/year [95%CI=-6.5% to -0.9%]. In Canada, incidence remained stable. Considerable geographic variation in risk was observed by US regions (eg, over four-fold risk in the Midwest and Southeast compared to the Northeast among men who have sex with men [MSM] with HIV). Anal cancer risk increased with a decrease in nadir CD4 count and was elevated among those with opportunistic illnesses. Anal cancer burden among US PWH is expected to decrease in future years (through 2035), but >70% of cases will continue to occur in MSM with HIV and people with AIDS. Conclusion Geographic variation in anal cancer risk and trends may reflect underlying differences in screening practices and HIV epidemic. MSM with HIV and PWH with AIDS will continue to bear most anal cancer burden, highlighting the importance of precision prevention.

中文翻译：

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北美艾滋病毒感染者近期和预测的肛门癌发病率趋势和风险

背景 HIV 感染者 (PWH) 的肛门癌风险较高。美国和加拿大 PWH 中近期肛门癌的发病模式仍不清楚。目前尚不清楚未来几年发病模式将如何演变。方法 利用北美艾滋病队列研究和设计合作的数据，我们调查了美国、加拿大和美国不同地区的绝对肛门癌发病率和发病率趋势。我们进一步估计了与未感染艾滋病毒的人相比的相对风险、各个亚组之间的相对风险，并预测了美国 PWH 中未来肛门癌的负担。结果 2001 年至 2016 年间，在美国，年龄标准化肛门癌发病率每年下降 2.2%（95%CI=-4.4% 至 -0.1%），特别是在西部地区（-3.8%/年 [95%CI =-6.5% 至 -0.9%]。在美国地区，发生率保持稳定（例如，与东北部发生性行为的男性相比，中西部和东南部的风险高出四倍以上）。患有 HIV 的男性 [MSM]）随着 CD4 计数最低值的减少而增加，并且在患有机会性疾病的人中，肛门癌的风险预计在未来几年（到 2035 年）会减少，但>70。结论 肛门癌风险和趋势的地理差异可能反映了筛查方法的根本差异，感染艾滋病毒的男男性行为者和感染艾滋病的艾滋病患者将继续患有大多数肛门癌。重担，凸显精准预防的重要性。