HIV, HPV, anal cancer, and HAART
HIV, HPV, anal cancer, and HAART
8-30-2005
Two new studies emphasize just how dangerous anal penetration is.
The studies examine the relationship among:
HIV -- the virus which causes AIDS;
HPV -- human papilloma virus, which is the most common sexually
transmitted pathogen, and of which there are more than 100 various strains or subtypes;
Anal cancer -- which is caused by HPV found in the anus -- that is,
"anal HPV"; and,
HAART -- "Highly Active Anti-Retroviral Therapy," the drug regime which is used to "manage" HIV infection. HAART is NOT a cure, but it is what at this moment is keeping alive a huge number of people infected with HIV.
Again, we now have two studies looking at the interplay among these
elements.
The more recent study, out today, reveals that 95% of HIV-positive gay men in SF have anal HPV infection, and more than 50% have grade 2 or 3 anal intraepithelial neoplasia (AIN), precursors of anal cancer.
Once again, HPV (human papilloma virus) causes anal and cervical
cancer, and is the most common sexually transmitted pathogen.
In this study:
95% (!) of the poz guys have anal HPV infection.
And more than 50% (!) have grade 2 or 3 anal intraepithelial neoplasia (AIN), precursors of anal cancer.
Those are shocking figures.
The article concludes that "HAART" -- "highly active antiretroviral
therapy" -- which we've been told has made HIV a "manageable illness" -- does NOT protect against HPV or anal cancer.
What's more, the study
found that the men on HAART actually had an increased risk of
AIN. Although the study does not suggest that HAART itself increases the risk of AIN, it does, at the very least, support the conclusion that HAART does not reduce the risk, and that the prevalence of anal cancer amongst gay HIV-positive men on HAART continues to increase.
[emphases mine]
Again: "the prevalence of anal cancer amongst gay HIV-positive men on HAART continues to increase"
Furthermore,
Having six or more HPV types increased the risk of any AIN 36-fold (95% CI, 7.4-171) and AIN 2 or 3, 108-fold (95% CI, 15-763) compared with no HPV infection.
That means the greater the number of types of HPV you've been exposed to, the greater the risk.
Something to remember in debates with analists when they claim that HAART has rendered both anal and promiscuity non-issues.
Not true.
Not in the least.
But wait!
Not only is there more -- it gets WORSE.
Because a second study, reported earlier this summer in AIDSMap reveals that men infected with HPV (human papilloma virus) are far more likely to contract HIV -- by a factor of more than three.
Infection with one subtype of the human papilloma virus (HPV) doubles the risk of becoming infected with HIV, and infection with several subtypes more than triples it, the third IAS conference heard on July 26th [2005].
Dr. Peter Chin Hong from San Francisco told the conference that the
EXPLORE trial of HIV-negative gay men in four US cities (Boston, Denver, New York and San Francisco) found that 81% of men who seroconverted (became HIV-positive) during a three-year period from January 2001 to January 2004 had HPV infection, as opposed to 50% of those who did not seroconvert.
Forty-three per cent of seroconverters had abnormal squamous cells in the anus, as opposed to 24% of non-seroconverters. The abnormal cells were extracted on swabs. Anal cytoscopy, which would have been able to detect the patches of anal intraepthelial neoplasia (AIN - abnormal and potentially precancerous skin) these cells came from, was not performed, which probably weakened the association between HIV infection and AIN, as swabs would not have detected every person with AIN.
The average number of HPV subtypes present in those infected was two. In univariate analysis, infection with one HPV subtype multiplied the risk of HIV infection by 2.0; with two subtypes by 2.4; and with three or more by 3.7. ...
Dr. Chin Hong said that in studies of cervical cancer, there was an
increased density of CD4 cells in patches of CIN (cervical intraepithelial neoplasia) compared with normal tissue, which suggests how the presence of HPV-associated skin lesions increases vulnerability to HIV infection.
If, unlike the average analist, you have half a brain, those findings should alarm you.
Why?
Because, as I've said, HPV is by far the most common sexually
transmitted pathogen.
And it's particularly common among men who are anally receptive.
One study found that 57% of HIV negative gay men carried anal HPV.
And that, of course, they'd been exposed through "receptive anal" --
bottoming:
In multivariate analysis the investigators found that the only
factor with a statistically significant association with HPV infection
was receptive sexual intercourse in the previous six months (p < 0.
0001). The number of male sexual partners in the previous six months was of border-line significance (p = 0.06).
"The striking finding of the present study is that urban HIV-negative [gay men] have high rates of anal HPV infection across all age groups", write the investigators, adding, "therefore, a high proportion of HIV-negative [gay men] may be at risk of developing anal cancer."
The investigators offer possible reasons for the higher prevalence of HPV infection in older gay men than that seen in women over 30. These include the longer persistence of HPV in the anus. However, they believe that the most probable explanation is new exposure to HPV "because the main risk factor for anal HPV infection was the number of male sexual partners in the preceding six months."
References
Palefsky J et al. Anal intraepithelial neoplasia in the highly active antiretroviral therapy era among HIV-positive men who have sex with men. AIDS 19 (13):1407-1414, 2005.
Chin-Hong PV et al. Age-specific prevalence of anal human
papillomavirus infection in HIV-negative sexually active men who have sex with men: the EXPLORE study. J Infect Dis 190 (on-line edition), 2004
Chin-Hong PV et al. Age-related prevalence of anal cancer precursors in homosexual men: the EXPLORE study. J Natl Cancer Inst 97: 896-905,
2005.
[emphases mine]
What's brewing out there literally in the bodies of gay and bi men is a perfect storm of sexually transmitted disease which will make AIDS look like the flu.
At least half a million gay and bi American men are infected with one or more strains of HIV, and a huge number of gay men, neg or poz, carry HPV -- usually multiple strains.
All that's needed is a new or newly-mutated pathogen -- a bacteria,
virus, prion, or protozoan -- to key off HPV or HIV and devastate the
anally-receptive.
And very possibly, their insertive partners, particularly if those
partners are uncircumcised.
Why?
Because yet another study found that uncircumcised men were three times more likely to contract HPV than circumcised men.
Reference: Baldwin, SB; Wallace, DR; Papenfuss, MR; et alia. Condom Use and Other Factors Affecting Penile Human Papillomavirus Detection in Men Attending a Sexually Transmitted Disease Clinic. (2004, October). Sex Transm Dis. 2004; 31(10):601-607.
So: we learn a little bit more with every study, but what we learn is not reassuring -- or at least it shouldn't be if you're a buttboy.
Because receptive anal puts you at enormous risk for HPV.
As does insertive anal if you're uncut.
And HPV infection puts you at heightened risk for other STD.
Including HIV.
What's the solution?
AVOID ANAL.
And avoid "men into anal."
Anal and in particular analists are the authors of these ills.
And they're also walking talking typhoid Marys.
They are a danger to their community.
How can you protect yourself?
Firstly, obviously, don't do anal.
And secondly, don't have any sort of sex with "men into anal."
Because men into anal are very likely to be infected with things you
don't want to get.
And they're also highly likely to engage in behaviors like
fingerfucking -- without any okay from you.
Thirdly, avoid group sex scenes of any sort.
There are IDIOTS -- and I do mean IDIOTS -- out there trying to
organize group Frot parties.
Group sex is the single most efficient way to spread pathogens.
Furthermore, those parties will inevitably attract large numbers of
"men into anal."
Because promiscuity is core to analism.
There are a huge number of buttboyz out there who will do anything with just about anybody so long as it's sex.
And those analist men can, just through the touch of a finger, spread their diseases to you.
Because if a buttboy fingers his anus, and then fingers yours, whatever was in his anus -- is now in yours.
Think of five or ten guys playing with their buttholes and rubbing
cocks.
There's no way to prevent that behavior in a group setting.
People who try to put together group Frot "parties" are the enemies of the Frot movement and of Frot men, and should be treated as such.
Fidelity and Frot is the way to go.
You need to know your partner, and to make clear to him BEFORE the
first date that you don't do anal and that you don't tolerate any sort of assplay.
Otherwise you'll end up with AIN and who knows what else -- too.
Take a look at the message thread on this board titled A huge mistake.
You cannot fool around with this and you cannot be promiscuous.
The analists are in deep denial about the basic facts of biology;
and about what happens when you have tens of thousands of gay and bi
men busily swapping pathogens.
Frot men need to see the world clearly;
and to understand the debilitating effects, both physical and
psychological, of promiscuity.
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