CD4 and anal carcinoma: Among these individuals, a low CD4 count was associated with an increased risk of anal cancer, and immunosuppression is critical in the early stages of SCCA development due to the persistent infections and decreased clearance of anal HPV [46,47,48,49,50]; moreover, in a large French cohort study of HIV+ patients, anal cancer incidence increased with the duration of time individuals spent with a low CD4 count and poorly controlled HIV infection [47].