References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Anal cancer is more common in people living with HIV than in the general population. The main risk factor is persistent infection with high-risk types of human papillomavirus (HPV), which is harder for the immune system to clear when HIV is present. With awareness, screening and HPV vaccination, much of this risk can be managed.
Here’s what you need to know.
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Why Is Anal Cancer More Common with HIV?
- HPV infections persist longer in people with HIV
- Chronic immune activation promotes cell changes
- Receptive anal sex increases HPV exposure to the anal canal
- Lower CD4 counts (past or present) raise risk
- Smoking further increases risk
Men who have sex with men (MSM) living with HIV have the highest risk, but anal cancer can affect anyone with HIV regardless of gender or sexual practice.
Symptoms to Watch For
- Bleeding from the anus (not just from haemorrhoids)
- Pain or pressure in the anal area
- A lump or mass near the anus
- Itching that doesn’t go away
- Change in bowel habits
- Unusual discharge
Many of these symptoms have other causes, but persistent symptoms should be checked.
Screening
| Method | What It Involves | Availability |
|---|---|---|
| Anal smear (cytology) | Swab of the anal canal, similar to a cervical smear | Available at some HIV clinics |
| High-resolution anoscopy (HRA) | Magnified examination of the anal canal | Specialist centres |
| Digital anorectal exam (DARE) | Physical examination | Standard at HIV clinics |
There is no national anal cancer screening programme in the UK yet, but some HIV clinics offer screening to higher-risk patients. The ANCHOR study from the US showed that treating anal precancer reduces progression to cancer.
Prevention
- HPV vaccination — the HPV vaccine is recommended for MSM up to age 45 in the UK. People with HIV who missed school vaccination may be eligible for catch-up doses
- Stop smoking — smoking significantly increases anal cancer risk
- Stay on ART — effective treatment supports immune surveillance
- Report symptoms early
- Regular screening if your clinic offers it
Treatment
Anal cancer is usually treated with a combination of radiotherapy and chemotherapy (chemoradiation). Surgery is reserved for cases that don’t respond. When caught early, outcomes are good. ART is continued throughout cancer treatment.
Read more: Cancer and HIV | Cervical screening and HIV | What is HPV?
Frequently Asked Questions
Should I ask for anal screening?
If you’re living with HIV and at higher risk (MSM, history of anal HPV, low CD4 counts), ask your HIV clinic whether anal screening is available and appropriate for you.
Does HPV vaccination help if I already have HPV?
The vaccine won’t treat existing HPV infections but can protect against types you haven’t yet encountered. It’s still worth having.
Is anal cancer curable?
When caught early, anal cancer responds well to treatment. Chemoradiation cures most early-stage cases.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
