Dr Eliane Rohner discusses the risk of anal cancer among people living with HIV, with a particular focus on sub-Saharan Africa. Using medical claims data from an HIV management programme in South Africa, this cohort study examined the relationship between CD4 cell count, HIV viral load, and anal cancer risk. The findings show that low CD4 counts and high viral load are associated with a substantially increased risk of anal cancer, highlighting the importance of immune monitoring and viral suppression as potential strategies for cancer prevention in high-burden settings.