Special Report: Wellness Conference - The Intersection of Cancer and HIV

A report from the Men’s Health and Wellness Conference

Some subtypes of Human Papilloma Virus (HPV) cause genital cancers on both sides of the viral divide. With a weakened immune system, the HIV infected have much higher risk for developing genital cancers.

Dr. Elie Schochet (Colorectal and General Surgeon, and the “Happy Heine” talks) spoke about cancer at the Men’s Health and Wellness Conference of 2015. Except for the references to information from the CDC and the American Cancer Society, the following roughly summarizes what Dr. Schochet said.

The cancer-surveillance system of a healthy immune system protects against cancer. When that surveillance system identifies a cancerous cell, a healthy immune system will clear or suppress the cancer.

Even with anti-retroviral treatment, an immune system infected with HIV does not function as a healthy immune system. It displays a chronic activation and inflammation that weakens it. As people age, their immune system begins to decline, which further weakens that system. This natural decline of an HIV-weakened immune system leaves people living with HIV at risk for cancers.

Hormonal-related cancers (breast and prostate) occur less often among the HIV infected than among the HIV uninfected. In contrast, viral-related cancers occur more often among the HIV infected. Viral related cancers include the following: HPV (anal cancer), Epstein-Barr (Hodgkin’s Lymphoma), Hepatitis C (liver cancer), and Human Herpesvirus 8 (Kaposi’s sarcoma).

According to the CDC, people transmit HPV more often than any other STD. HPV has many subtypes, some of which cause genital warts. Others cause cancers of the anus, cervix, penis, vagina, and throat. The subtype that causes genital warts differs from those that cause cancer. The Gardasil vaccine protects against the cancer-causing subtypes. As too many people already have HPV, the CDC does not consider this vaccine effective for most adults. The CDC only recommends the vaccine for gay bi men up to age 26.

According to the American Cancer Society, researchers have divided cancer into four stages based on disease progression. In Stage I Cancer, the cancer is isolated. In Stage IV Cancer, the cancer has spread throughout the body.

Dr. Schochet reported that most initial diagnoses of anal cancer occur at Stage III. In order to improve life expectancy, more diagnoses have to occur at earlier stages. This requires earlier screening (anal pap smears) for HPV infection. Schochet recommended that people living with HIV should have regular anal pap smears and colonoscopies earlier than the HIV uninfected. Schochet also recommended that all people living with HIV have the Gardasil vaccination upon HIV diagnosis. Schochet recommended regular anal pap smears for gay bi men without HIV infection, as people on that side of the viral divide also develop anal cancer.

According to the CDC, HPV causes about 27,000 new cases of cancer per year in the U.S. (see chart). The CDC, however, failed to break this data down into useful information for the LGBT communities. This data hides transgender people. Almost all the anal cancers among males occur among gay bi or other men who have sex with men. This data shows that many more men than women develop throat cancer from HPV infection. This data reflect the entire population, not the LGBT population. No evidence currently exists that gay bi men comprise a large number of the men with throat cancer. While no consensus yet exists, some researchers have argued that vaginal fluids may be a more efficient oral transmitter of HPV than semen.

As HIV infection has come more under control, the threat to health of other STDs, like syphilis and HPV, has increased. The LGBT communities need to become more aware of these other STDs


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