CROI 2011

I recently returned from the 18th Conference on Retroviruses and Opportunistic Infections or what is more commonly referred to as CROI. Considered by most HIV clinicians to be the most important HIV meeting of its kind, CROI gathers physicians, scientists and healthcare providers from around the world.

One of the most interesting symposiums addressed the growing number of cases of anal cancer. Over 5,000 cases of anal cancer are diagnosed annually. A little more than half are among women. Anal cancer develops from the human papilloma virus (HPV), the same organism implicated in cervical cancer. HPV is transmitted via contact through receptive intercourse, which begs the question: If more than half the cases of anal cancer are among women, then how much anal sex do women engage in?

Very little has been reported about anal cancer rates. Part of the issue is the stigma attached to this sex act. Farrah Fawcett supposedly died from complications related to anal cancer. Upon her death I read many articles that said she died from colon cancer.

Further analysis of the date showed that HIV positive men who have sex with men (MSM) had high-grade anal lesions 2- 3 times more than HIV negative MSM’s. High grade lesions can go onto become cancerous.

Gardasil is an FDA approved vaccine used for the prevention of HPV serotypes 6, 11, 16 and 18. The latter two are potentially cancerous. Initially approved only for women, the indication now includes men. Unfortunately, Gardasil is not always covered by insurance. Given in 3 separate injections over 6 months, Gardasil can cost over $300 for the entire series.

It’s important to discuss your sexual practices with your doctor. The consensus at CROI is that Gardasil should be offered to all women and MSM’s, especially those with a history of HPV.



  1. Posted March 11, 2011 at 7:21 pm | Permalink

    Hi Doc, I wondered about Farrah. Is anal cancer always caused by sex and what sign would u see to cause concern, other than an hpv wart? Can u feel an internal leison? how would u detect this early, an anal pap or will there be a symptom??

  2. Gregorio
    Posted March 11, 2011 at 8:04 pm | Permalink

    I just discovered your blog recently and I must say I am thrilled to read your address the topic of HPV infections and the health risks that come with them. Very rarely does anyone in the gay community speak of the seriousness of this issue yet I have read that somewhere in the range of 60%-70% of gay men are infected with HPV. I have to confess, Farrah Fawcett’s death from anal cancer was a wake up call for me; watching the documentary she made on what she went through dealing with the disease frankly was frightening. I hope this is a topic you will continue to speak out on and educate gay men that we must be aware and talk about HPV and the cancers that are connected to the infection.

  3. spinellimd
    Posted March 11, 2011 at 11:03 pm | Permalink

    Anal cancer is caused by HPV which is transmitted mainly through anal sex. Warts don’t cause cancer. That’s why you should get an anal pap smear.

  4. Posted March 12, 2011 at 12:41 pm | Permalink

    Thank you, I had one, now I understand better why the Dr. did it.

  5. edfu
    Posted March 13, 2011 at 4:13 am | Permalink

    HPV can infect the anal canal by means other than “anal sex,” strictly speaking and in the way it’s usually understood. It can be spread via digital-anal and oral-anal contact in addition to penile-anal. It can also be caused through self-innoculation, from one’s own HPV-infected penis to the anus via digital-anal. HPV is spread through skin-to-skin contact.

  6. D
    Posted April 1, 2011 at 4:51 pm | Permalink

    So, if someone has had hpv, and had the anal warts removed, can they still get the gardasil vaccine? will it offer any protection to someone who has already hap the hpv virus?
    Thank You!

  7. spinellimd
    Posted April 1, 2011 at 8:38 pm | Permalink

    I recommend Gardasil to anyone who has had HPV even if they’ve had them removed and especially if they are HIV positive.

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