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to Section One | to Arts & Entertainment
posted Friday, March 22, 2019 - Volume 47 Issue 12
Know the facts about HIV and cancer
Section One
ALL STORIES
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Know the facts about HIV and cancer

by Colin Fields, MD - Kaiser Permanente

When it comes to our health, I have some good news, and some bad news.

The good news? We're doing a great job in King County at HIV treatment and prevention.
For over three years now, King County has met the World Health Organization's 90-90-90 goal. The objective of this goal is to have 90 percent of persons living with HIV know their HIV status, 90 percent of these individuals prescribed life-saving antiretroviral therapy, and 90 percent of these prescriptions resulting in undetectable viral levels. This continues to be an astounding accomplishment for our region, one of the only places in the world to accomplish and maintain this goal. Since undetectable equals untransmittable, the hope is that this achievement will also lead to success in decreasing the local transmission of HIV.

We can already see how the rates of HIV transmission are declining. According to the 2018 Washington State & King County HIV/AIDS Epidemiology Report, 'The number of new HIV diagnoses among King County residents is at its lowest level since 1994.' In addition, when people living with HIV use antiretroviral therapy it not only saves lives, it also increases life expectancy. King County has an estimated 6,907 residents living with HIV. Nearly half of all local people living with HIV are over the age of 50, a welcome and fortunate change from the early years of this epidemic. This means people living with HIV are becoming our elders.

At the same time, the effects of HIV on the aging body are presenting new medical challenges. Our community in King County lost 79 people who were living with HIV during 2017 with the leading causes of death being cancer and heart disease.

The bad news? Colorectal cancer continues to kill us.
March is Colorectal Cancer Awareness Month. The Colorectal Cancer Alliance reports that colorectal cancer is the 'second leading cause of cancer death in men and women combined in the United States.'

Rectal and anal cancers disproportionately affect persons living with HIV. The immune systems of people with HIV struggle to clear infections from human papillomavirus (HPV), and we know that there are some strains of HPV which are more likely to turn into anorectal cancer. Half of men living with HIV and twenty percent of women living with HIV have cellular changes from HPV found in the anus. Women living with HIV who have abnormal pap smears are at even higher risk. We need to do more research about the screening, treatment, and follow-up of anorectal cancers in people living with HIV.

Fortunately, three sites in the Seattle area are part of a national study called ANCHOR (Anal Cancer HSIL Outcomes Research) with the goal of the study being, 'to find the best way to prevent anal cancer among HIV positive men and women.' Sites here in town are enrolling HIV positive patients, screening them for anal dysplasia, and randomizing them to different treatment groups followed by monitoring. If you're HIV positive, you may be eligible to participate as a subject in this study (https://anchorstudy.org/) to better understand HIV and anorectal cancer.

HIV care continues to evolve and address new challenges.

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