We surveyed trends in incidence (1995-2012) and risk factors for anal cancer in the Dutch HIV positive population. After an initial increase with a peak incidence in 2005-2006 of 114 (95% CI 74-169) in all HIV+ patients and 168 (95% CI 103-259) in HIV+ MSM, a decline is seen to 72 (95% CI 43-113) and 100 (95% CI 56-164) respectively in 2011-2012. Low nadir CD4, alcohol use and smoking were significantly associated with anal cancer in MSM. In conclusion, anal cancer remains a serious problem in predominantly HIV+ MSM. However, it seems that incidence rates are leveling off. Copyright