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French Study Finds Increased Anal Cancer Risk Despite ART

December 19, 2012

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Prevention

Here are some steps that might help reduce the future risk for HPV-related cancers, including anal cancer:

Early Initiation of ART

Starting ART before the CD4+ count falls to low levels helps to reduce damage to the immune system. A stronger immune system should be better able to fend off cancers.

HPV Vaccination

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There are two vaccines -- Cervarix and Gardasil -- that provide protection against two strains of HPV that are associated with cancer. One of these vaccines (Gardasil) also provides protection against ano-genital warts. Although the effectiveness of these vaccines was tested in HIV-negative people, researchers at the U.S. National Cancer Institute recently estimated that these vaccines could provide "substantial" protection against HPV-related pre-cancer and cancer particularly in HIV-positive people. Speak to your doctor about coverage for this vaccine in your region.

Tobacco and Other Substances

Reducing exposure to factors associated with cancer (such as tobacco smoke, excessive alcohol and injecting street drugs) is a good step. Another important step is getting help for the mental and emotional health conditions that often underpin some people's susceptibility to addictive behaviours and substance use.

Safer Sex

This helps to protect people not only from HIV infection (and for HIV-positive people, new strains of the virus) but also from many sexually transmitted infections. Correct and consistent use of condoms offers some protection from (re)infection with HPV.

Cancer Screening

Anal cancer screening programs for HIV-positive people may be available in some larger cities. Often such programs are funded as part of research studies and may not be the standard of care. Speak to your doctor about the availability of this screening in your region.


Resource

Canadian Cancer Society -- Anal cancer overview


References

  1. Piketty C, Selinger-Leneman H, Bouvier AM, et al. Incidence of HIV-related anal cancer remains increased despite long-term combined antiretroviral treatment: Results from the French Hospital Database on HIV. Journal of Clinical Oncology. 2012; in press.
  2. de Pokomandy A, Rouleau D, Ghattas G, et al. HAART and progression to high-grade anal intraepithelial neoplasia in men who have sex with men and are infected with HIV. Clinical Infectious Diseases. 2011 May;52(9):1174-81.
  3. Coutlée F, de Pokomandy A, Franco EL. Epidemiology, natural history and risk factors for anal intraepithelial neoplasia. Sexual Health. 2012;9:547-555.
  4. Appay V, Fastenackels S, Katlama C, et al. Old age and anti-cytomegalovirus immunity are associated with altered T-cell reconstitution in HIV-1-infected patients. AIDS. 2011 Sep 24;25(15):1813-22.
  5. Barrett L, Fowke KR, Grant MD. Cytomegalovirus, aging, and HIV: a perfect storm. AIDS Reviews. 2012 Jul;14(3):159-67.
  6. Deeks SG, Verdin E, McCune JM. Immunosenescence and HIV. Current Opinion in Immunology. 2012 Aug;24(4):501-6.
  7. Dock JN, Effros RB. Role of CD8 T cell replicative senescence in human aging and in HIV-mediated immunosenescence. Aging and Disease. 2011 Oct;2(5):382-397.
  8. Rasmussen LD, Kessel L, Molander LD, et al. Risk of cataract surgery in HIV-infected individuals: a Danish nationwide population-based cohort study. Clinical Infectious Diseases. 2011 Dec;53(11):1156-63.
  9. Sahasrabuddhe VV, Castle PE, Follansbee S, et al. HPV genotype attribution and estimation of preventable fraction of anal intraepithelial neoplasia among HIV-infected men who have sex with men. Journal of Infectious Diseases. 2012; in press.
  10. Nyitray AG, Carvalho da Silva RJ, et al. Six-month incidence, persistence, and factors associated with persistence of anal human papillomavirus in men: the HPV in men study. Journal of Infectious Diseases. 2011 Dec 1;204(11):1711-22.
  11. Van de Velde N, Boily MC, Drolet M, et al. Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis. Journal of the National Cancer Institute. 2012 Nov 21;104(22):1712-23.
  12. Phillips DH, Hewer A, Scholefield JH, et al. Smoking-related DNA adducts in anal epithelium. Mutation Research. 2004 Jun 13;560(2):167-72.
  13. Reepalu A, Blomé MA, Björk J, et al. The risk of cancer among persons with a history of injecting drug use in Sweden -- a cohort study based on participants in a needle exchange program. Acta Oncologica. 2012 Jan;51(1):51-6.
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This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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