Progressing from dysplasia to anal cancer; I've had enough!!

Question

Dr. Dezube: I am 32 years old and have been dealing with HIV for the better part of the last ten years. I also have human papillomavirus and, consequently, have been dealing with high-grade anal dysplasia for six years. What has been truly frustrating about my experiences with dysplasia is the fact that, every six months, a new high-grade lesion is found and, as a result, I'm being forced to endure the tribulations of rectal surgery twice a year.

Simply put, I've had enough. I can no longer go through with this incredibly barbaric and painful process... I'm opting to forgo future surgeries, at least for the near future.

But here's what I don't understand: while it's clear that HIV-positive gay guys such as myself are at a higher risk for anal cancer (given the higher rates of anal dysplasia), I still don't understand if being HIV-positive actually speeds up the rate by which high-grade dysplasia develops into anal cancer.

I've read that it usually takes ten years (or more) for high-grade CERVICAL dysplasia to become cancerous (if, in fact, it does occur) and that HIV doesn't seem to have an influence on this progression rate. Unfortunately, I can't find any similar information related to anal cancer and, well, need to know if the odds are stacked against me simply because I'm also HIV infected.

Thanks much.

Answer

I feel for you. These repeat surgeries sound unpleasant, to say the least. Being HIV-positive does inded speed up the rate by which high-grade dysplasia develops into anal cancer. However, even if you were to be HIV-negative, everything you describe could still be happening. Unfortunately there is often little choice but to undergo periodic examinations and surgeries. Some surgeons will treat the base of the dysplasia lesions with a laser (carbon dioxide laser) in an attempt to decrease recurrence. In really bad cases of HPV disease, some clinicians will treat their patients with interferon. Hang in there, HPV vaccines are in early clinical trials. It's only a matter of time until such a vaccine is available. It's hoped that these vaccines will help guys like you who already have the HPV virus. (HPV is short for human papilloma virus and is the virus which causes anal warts, dysplasia, and cancer). Aldara cream is quite effective for external warts. If your warts weren't too far in, then perhaps aldara can help. Good luck. BD.