Combating Anal Cancer Among HIV-Positive MSM in Asia

Original Article:

In 2008, the Thai Red Cross AIDS Research Centre, a TREAT Asia network member in Bangkok, opened the Anonymous Clinic—a sexual health clinic with specific services for men who have sex with men (MSM). Because MSM living with HIV are twice as likely as those without HIV to develop the anal cancer associated with human papillomavirus (HPV), the clinic determined to start screening its patients for anal precancers.

Using funding from amfAR’s MSM Initiative (now the GMT Initiative), they purchased the high-resolution anoscopy microscope necessary to diagnose and treat both anal warts and precancerous anal lesions, and began providing anal Pap smears and treatment free of charge. This not only benefited their patients, it also generated some of the first data about HPV and anal neoplasia—the final stage the lesions reach before developing into cancer—among MSM in a resource-limited setting in the Asia-Pacific. TREAT Asia has been supporting the project since 2009.

The Thai Red Cross team found that approximately 10% of HIV-negative and 20% of HIV-positive MSM in Bangkok had pre-cancerous lesions, and almost 60% of positive MSM were infected with the strains of HPV most likely to progress to cancer, twice the rate of negative MSM. HIV-positive MSM were also much less likely to clear the infection without treatment, increasing their risk of developing anal neoplasia in the future.

“The results have generated ongoing discussions in Thailand about studying the cost-effectiveness of an anal cancer screening program and including anal cancer screenings in the National Guidelines for HIV Treatment and Prevention for the first time,” says Dr. Nittaya Phanuphak, from the Thai Red Cross, who heads the study.

In 2012, three additional TREAT Asia network members—Udayana University & Sanglah Hospital in Bali, Indonesia, Cipto Mangunkusumo Hospital in Jakarta, Indonesia, and the University of Malaya in Kuala Lumpur, Malaysia—approached the Thai Red Cross about establishing similar programs at their facilities. The participating clinicians from all four sites then established the Anal Neoplasia Study in the Asia Pacific (ANSAP).

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