Anal dysplasia is on the rise for people living with HIV. Because people with HIV are now living longer, patients are facing a new set of health risks such as heart disease and now anal cancer. A national study has been launched, the Anchor Study, to examine the link between HPV and HIV, coinciding with the upcoming anal cancer awareness day on March 21.
Anal dysplasia refers more specifically to pre-cancerous lesions most commonly caused by HPV before the condition potentially worsens to cancer. HPV causes these pre-cancerous lesions typically treated in the vagina but is now being treated in the anus as well ( for both men and women ).
Despite HIV-positive people living with higher T-cell counts and immune systems that normally aren't susceptible to opportunistic diseases, they still face a higher risk of becoming infected with HPV. Once infected, the time from HPV to cancer happens more quickly for those with HIV versus the typical infection rate of 30 to 40 years.
Half of HIV-positive men have cell changes in their anus caused by HPV while about one in five HIV-positive women have the same cell changes. Those women with abnormal cervical pap smears may be at a higher risk for anal cancer, independent of whether they have had anal sex ( Anchor Study ).
Like cervical cancer, anal cancer is often symptom-free.
"No one knew that cervical cancer was preventable before the use of Pap smears became widespread in the 1960s and cut the incidence of the disease by 80 percent," said Dr. Joel Palefsky, the study's principal investigator and protocol chair.
It is this link between HIV and HPV that the Anchor Study is examining. The primary goal of this study is to collect data that would influence insurance companies to cover routine anal cancer screenings and preventative treatment. The theory is that anal cancer, like cervical cancer, can be prevented by these routine screenings and removal of pre-cancerous cells.
"Since we're in the era of evidence based medicine, they want to be able to see that by doing something you'll decrease the incidence of cancer by a certain amount," explained Dr. Gary Bucher. "A controlled trial like this should get us that answer."
Bucher heads the Anal Dysplasia Clinic ( ADC ) Midwest in Chicago and is a leading anal dysplasia and anal cancer-prevention specialist. Bucher is the only certified high-resolution anoscopy ( HRA ) provider in the Midwest used to evaluate and treat anal pre-cancerous lesions.
The "anchor" in Anchor Study stands for Anal Cancer HSIL Outcomes Research. The study seeks to recruit people with these High Grade Squamous Intraepithelial Lesion ( HSIL ) and randomly assign them to a group that will receive treatment of the lesions or a monitoring group. Participants will be followed for five years to compare the results of each group, allowing for conclusion of whether screening and treatment of HSIL are effective strategies in preventing anal cancer ( Anchor Study ).
The ADC is one of 12 sites throughout the U.S. participation in the study.
"We feel comfortable with doing that because if we're going to following everyone every six months or if there's something suspicious more frequently we'll catch things early and be able to treat them," said Bucher.
A secondary analysis being conducted through the Anchor Study involves doctors collecting specimens and looking at biomarkers or other ways that HIV influences the progression to anal cancer. Also, doctors hope to learn to predict which lesions will lead to anal cancer over time.
The Anchor Study's main goal is to determine if these screenings decrease the rate of incident of anal cancer.
"In the Midwest, we're trying to get the word out because a lot of people aren't screening for this because patients don't want to get a rectal exam and doctors really don't want to do the rectal exam either," Bucher said. "But that's how you will find things."
There is one preventative measure available which is the Gardasil vaccine with a recently approved vaccine out that prevents against nine different strains of HPV.