A Deadly Nexus: Cancer and HIV in Asia

TREAT Asia Symposium Gathers Global and Regional Experts

Dr. Nittaya Phanuphak (center) of the Thai Red Cross AIDS Research Centre with study physician Dr. Nipat Teeratakulpisarn and study nurse Ms. Amornrat Sukjitpaiboonphol.

March  2011—Confronting the increasing burden of cancer among people living with HIV/AIDS in Asia, TREAT Asia co-sponsored a two-day symposium in November bringing together regional and global experts with the aim of deepening understanding of cancer and its relationship to HIV.

"People with HIV are living longer because of highly active antiretroviral treatment [HAART], but because they have a higher risk of developing certain cancers associated with other viral infections, they can still die younger," said TREAT Asia Director Annette Sohn, M.D. "The situation is amplified in Asia and other resource-limited regions where cancer is hard to diagnose and treat since medical resources are not usually available."

Because of the strong association of human papillomavirus (HPV) with anal and cervical cancers, a number of presentations addressed current research into these two illnesses. Studies have shown that HIV-positive women and men who have sex with men (MSM) are much more likely to have HPV-associated cancers. In the US, HPV is now preventable through a childhood vaccine, but the cost is prohibitive in Asia. "We don't have the infrastructure in Asia for cervical cancer screening in the general population, but it's desperately needed among women with HIV given the much higher risk," said Liesl Messerschmidt, TREAT Asia's director of research.

High rates of HPV-related anal dysplasia have been identified by the Thai Red Cross AIDS Research Centre in Bangkok via a screening program supported by TREAT Asia through a grant from the US National Institutes of Health's IeDEA (International Epidemiologic Databases to Evaluate AIDS) program.

The Thai study has raised significant concerns about the extent of anal cancer risk among MSM, according to principal investigator Nittaya Phanuphak, M.D. The study is now looking at proteins associated with anal cancer in order to determine if men who are more likely to progress to cancer can be more accurately identified. The Thai Red Cross's research is rapidly advancing the understanding of anal cancer risk, progress that is leading to opportunities to collaborate with other US and Australian investigators.

Another area of growing interest in Asia is liver cancer associated with viral hepatitis infection. Many of the local HIV epidemics in the region are connected with injection drug use and studies show that upwards of 90 percent of IDUs in Asia can also be infected with hepatitis C, which puts them at risk for liver cancer; this risk is even greater in the context of HIV infection. But because the costs of treating hepatitis B and C are prohibitively high, local clinicians lack the tools to help patients who may have more problems with liver disease than with their HIV infection.

The symposium, which was supported by the IeDEA program, brought together 61 participants from nine countries to hear presentations from the World Health Organization's International Agency for Research on Cancer; the US National Institutes of Health's National Cancer Institute; regional medical centers and universities; and Australia's National Centre in HIV Epidemiology and Clinical Research, which co-sponsored the symposium.