Know your enemy

Juliet Bennett
Independent Nurse Advisor

Last October the US-based HealthDay News headlined: ‘New research on anal cancer, a rare disease that’s often caused by a sexually transmitted virus, found that nearly one-third of men with this form of cancer were HIV-positive’. The article was citing a publication from the October 2012 issue of the Journal of the National Cancer Institute [1].
We also know that anal cancer occurs far more commonly in HIV-positive (and HIV-negative) men who have sex with men (MSM) compared with the general population, with recent US findings revealing rates 30 to 100 times higher than that of the general population [2,3]. The entire male population has seen almost a threefold rise in incidence of infection with the human papilloma virus (HPV) in the past 30 years [4], the relevance of which will be discussed later in this article.
Anal intraepithelial neoplasia (AIN) has been rather overlooked historically by both researchers and healthcare providers (HCPs). There has been a lack of large-scale prospective studies showing whether or not screening is beneficial and cost-effective, and there continues to be much debate around treatment efficacy. Perhaps a degree of ‘embarrassment factor’ associated with the nature of this disease, on the part of both HCPs and patients, or an unwillingness to acknowledge the threat it poses to certain populations, have also contributed to its low profile. In addition, and perhaps surprisingly, even the success of HAART in recent decades has conferred no substantial benefit in reducing incidence of neoplasia [5]. In fact, several studies have demonstrated a higher incidence of anal cancer since the introduction of HAART [6], although of course this may be due to disease progression in people who are now living longer with HIV and HPV infection. Read more…