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Risk of Cancer
Jan 7, 2012

Hello Doc,

Thank you for your quick reply about VL blips. Recently I read about higher Cancer risk among HIV+ people even with CD4 above 500.

It's written : "Higher rates of Kaposi's sarcoma, non-Hodgkin's lymphoma, Hodgkin's lymphoma, melanoma, and anal and liver cancer were found among HIV-positive members. The HIV patients had 200 times the risk for Kaposi's sarcoma, a 40 percent higher risk for liver cancer, and a 55-fold increase for anal cancer."

My question ; If I'm a Heterosexual ,do I still have the risk for anal cancer? and how can we do the early detection for liver cancer?

Thank You

Response from Dr. Young

Hello and thanks for posting.

As people living with HIV live longer and healthier, without the usual AIDS complications, we are focusing attention to the medical issues related to long-term survival and aging. These include heart, liver, kidney and bone diseases, cognitive health and cancer. Most of these conditions are not different among straights and gays.

Anal cancers are generally associated with infection with human papilloma virus- the virus that causes genital warts. While it might be convenient to say that the risk is only among those people (male or female) who have had anal sex, increasing data suggests risks among HIV-infected heterosexual men or among women who have never had anal sex. This scientific publication from the French Hospital Cohort on the increased case rates of anal cancer and concludes (in part), that "one possible reason for heterosexual men having anal cancer would be the under-reporting of men-men sex. Nevertheless, recent data suggest that opportunistic HPV infection and AIN may occur in the anal canal of immunocompromized patients who have not practiced receptive anal intercourse".

As for liver cancer, in positives, risks are related to infection with hepatitis B and hepatitis C virus and/or alcohol dependency. So, if you're not HBV or HCV positive, then vaccination to prevent B and practicing safe habits to avoid new HCV infection is important. Screening practice is generally based on the AASLD Practice Guidelines and suggest performing liver ultrasound tests (with or without blood tests for a cancer marker, alpha fetoprotein in at-risk individuals. The European AIDS Clinical Society Guidelines suggest that among positives with cirrhosis, these tests be performed every 6 months.

Hope that helps. BY



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