This large U.S.-Canadian study found that HIV-positive people have higher rates of new anal cancer than HIV-negative people or people in the general population. The comparative rate is highest for HIV-positive gay or bisexual men, who have over an 80 times higher new anal cancer rate than HIV-negative people.
The anal cancer rate rose sharply from 1996-1999 (the first years of the combination antiretroviral era) to 2000-2003. That high rate remained about the same in 2004-2007.
The higher anal cancer rate in HIV-positive people than in HIV-negative people is not surprising because both HIV and HPV (which can cause anal cancer) can be passed from one sex partner to another. People with many sex partners and people who don't use condoms during sex run a high risk of getting infected with HIV or HPV.
Always wearing a condom during anal or vaginal sex greatly lowers the risk of HIV or HPV infection. There are also vaccines to protect people from HPV infection. The CDC recommends the vaccine Cervarix or Gardasil for all 11- and 12-year-old girls and for all girls and women from 13 to 26 years old who did not get any or all of the three vaccine shots when they were younger.2 Gardasil is available for boys and men from 9 through 26 years of age. Research must determine whether these vaccines will prevent anal cancer in people with HIV.
The American Cancer Society lists the following risk factors for anal cancer: HPV infection, HIV infection, many sex partners, receptive anal intercourse, smoking, low CD4 count, and previous cancer of the cervix, vagina, or vulva.5 At the link provided at reference 5 below, the American Cancer Society offers helpful online information explaining anal cancer, its causes, risk factors, and prevention, early detection, and treatment.
Anal cancer can be detected early with a digital rectal exam. A Pap test can detect anal cancer or cell changes that may develop into anal cancer. The New York State AIDS Institute recommends yearly digital rectal exams for all HIV-positive people and Pap testing for (1) gay or bisexual men, (2) people who have had anal or genital warts, and (3) women with abnormal cells in the cervix or vulva.6 The researchers who conducted this study1 note that further research is needed to determine whether this approach will lower anal cancer rates in people with HIV.
The U.S.-Canadian research team believes their results suggest that anal cancer prevention efforts should be aimed at all people with HIV infection, not selected groups.
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