In the United States, the rate for anal cancer in the general population is 1 case per 100,000 people; among HIV-negative men who have sex with men the rate increases to 35 cases per 100,000 people.
For HIV-positive gay and bisexual men, the rate is estimated to be between 75 to 115 cases per 100,000 people. It seems to affect those of us who have lived longer with HIV, have had detectable HIV viral load for a few years, have had anal warts (debatable) and/or had lower CD4 cells in our HIV infection.
There is good evidence that HPV causes many cases of anal cancer. More than 100 subtypes of HPV have been found. The subtype known as HPV-16 is often found in anal cancer lesions and is also found in some anal warts. Another type, HPV-18, is found less often. Most anal warts are caused by HPV-6 and HPV-11. Warts containing HPV-6 or HPV-11 are much less likely to become cancerous than those containing HPV-16. Some reports show that many HIV+ long term survivors have been exposed to many HPV genotypes, including the oncogenic (cancer producing) ones.
There are really no guidelines yet about how to diagnose and treat anal dysplasia. The University of California in San Francisco is leading the way in studying different methods of detection. They are researching three forms of tests: an anal Pap smear (where the doctor swabs an area of the anus to remove surface cells), a high resolution anoscopy (where a doctor uses a special microscope to look at the anus), and a biopsy (where the doctor scrapes away an area of the anus to remove surface cells).
The good news is that a 5-year study designed by Dr. Joel Palefsky and his team is now enrolling patients to study the long term effect of performing high resolution anoscopies (HRA) and infrared coagulation (IRC) in HIV+ men and women with dysplasia versus not performing the IRC to determine if IRC is an effective way to prevent progression to cancer.
I had the pleasure and honor to interview Dr. Palefsky, one of the world's experts on HPV infection in HIV+ people, and Jeff Taylor, the nation's top HPV/HIV activist. I think everyone will agree with me that this video includes most of the information needed to proactively prevent and/or treat HPV related anal cancer as we age with HIV. You can also find out information on how to volunteer to be monitored in Dr. Palefsky study.
Dr. Joel Palefsky is the Chair of the HPV Working Group of the AMC and is the head of the AMC HPV Virology Core Lab. He has extensive experience in studying the biology of HPV infection, HPV infection in HIV-positive men and women, HPV vaccines and in the design and implementation of clinical research trials of HPV-related disease. He has published over 250 papers and is the PI on several laboratory-based and clinical research studies of HPV-associated neoplasia, particularly in the setting of HIV infection. Anal dysplasia occurs in men and women and is especially common among patients infected with the human immunodeficiency virus (HIV). He also specializes in the biology and development of new treatments for HPV and Epstein-Barr virus. He is the founder and president of the International Anal Neoplasia Society and President-elect of the International Human Papillomavirus Society. He is actively involved in training students in clinical and translational research and has led the Doris Duke Charitable Foundation (DDCF) program at UCSF since its inception in 2001. He was the head of the Roadmap T32 student research program in 2005 before it transitioned to the TL1 program, and has been the leader of the Clinical Translation Science Awards (CTSA) TL1 program at UCSF since its inception in 2006. Dr. Palefsky plays an active role in promoting student research programs at UCSF, advising and recruiting students supervising their research and providing active career guidance. He has won numerous student teaching awards.
Jeff Taylor is a 25+ year survivor of AIDS and cancer, and has been active in HIV research advocacy since enrolling in the ACTG's first AZT trials in the late 80's. He served for five years on the ACTG's Community Constituency Group (now CSS) -- where he was the community liaison to the Complications Research Agenda Committee (now OpMan), and was on the ACTG's original metabolic focus group formed to study emerging lipodystrophy. Currently, he continues to serve on the UCSD Antiviral Research Center's Community Advisory Board, the NCI's AIDS Malignancy Consortium as a community representative to their HPV Working Group and ANCHOR Study, DHHS Antiretroviral Guidelines Panel, co-chairs the community advisory board for the CARE Collaboratory, and on the Program Committee for CROI. He also serves on the AIDS Treatment Activists Coalitions Drug Development Committee -- which meets regularly with pharma and FDA on HIV drug development issues. Locally, Jeff produces a monthly treatment education series on HIV treatment issues for HIV patients & providers, serves on the regional Ryan White Planning Council, and co-chairs the Client Advocacy Committee of the Desert AIDS Project.