Gay Cancer -- Again

The term "gay cancer" was used 18 years ago to describe HIV and AIDS, but now new data from the 6th Conference on Retroviruses and Opportunistic Infections shows that a new cancer appearing at unusually high rates is affecting gay men and gay HIV+ men in amazing proportions. Anal cancer in men who have sex with men is now being reported at alarmingly high rates, and the rate in gay men with HIV/AIDS is even higher.

Anal cancer is very similar to cervical cancer in women, and takes the form of tumors or lesions that appear in the anal canal. Studies now show that the rates of anal cancer are much higher in gay men and men who have sex with men (MSM) with HIV. Eight of every 100,000 women will get cervical cancer. Compare this to the numbers for men who have sex with men: 35 of every 100,000 will develop anal cancer. (The risk in the general population is 0.9 per 100,000.)

Estimates of anal cancer in people who are HIV+ are even more staggering. One study shows that HIV+ people are twice as likely to contract anal cancer as HIV-negative men, and that as an AIDS diagnosis approaches, the risk of anal cancer increases further. As the immune system weakens, lesions can develop and progress.

HAART therapy may actually be the reason we are now seeing an increase in anal cancer. Cancer and tumors take several years to fully develop and become noticeable. Before the advent of HAART, people were dying before these lesions and tumors were noticed. Today, as new medicines are keeping people alive longer, new issues like this are now appearing.

And, unlike some other diseases, anal cancer does not seem to improve with better HAART therapy. In one study, 28 men with anal cancer, low CD4 counts, and high viral loads, were given HAART therapy and saw good results virologically. But, only 1 of the 28 experienced a regression of lesions or cancer. This indicates that HAART may have little impact on anal cancer.

Like cervical cancer, anal cancer is caused by a virus, the human papilloma virus (HPV). Initially, the cervix or anal canal develops abnormal, pre-malignant changes called intraepithelial (the superficial layer of the anal canal) neoplasms. These changes gradually worsen and become an invasive cancer. Screening tests are available to look for early changes, a pap smear for women and a similar pap smear of the anal canal for men. This can be preformed easily with a Dacron swab.

If abnormal changes are noted, further investigation and possible surgical excision by a laser may be necessary. Or, there are currently three methods of non-surgical treatment:

1. Imiquimod. This is a topical agent that has limited effect because it so easily gets rubbed off.

2. Therapeutic vaccines. These may work, but one needs to have a strong immune system for vaccines to work well.

3. Onxy-015. This is a recombinant adenovirus that is about to enter clinical trial phase. It has the ability to kill cells infected with HPV.

Because of this data it is very important for all men who have sex with men to add anal screens to their health check-ups.