And now another thing

[PozBrian]

I go to a military HIV clinic. If they are anything, it is thorough. Last time I saw my Dr. I got anal PAP smear for HPV.  The results of that was a phone call saying that I needed to come in for further tests. Which I did. The test was a biopsy. That went fine but the result of that was not good, high grade squamous intraepithelial cells. So now I have a referral to general surgery to have them removed. I'm sure it will be much more technical but all I can think of is rotor rooter. 

Does anyone have any experience with this kind of procedure? What can I expect? What do I need to watch out for?

[jkinatl2]

If what they found was similar to anal warts, then yes, many of us have had them reomoved. It's uncomfortable (less so than in the "old days" without lasers and such) but you will be well-served by having a lot of fiber and water the days before and after. You will want/need things to "go" smoothly, to say the least.

They offer pain pills sometimes - avoid them if you can. Pain pills tend to constipate, so you are saving yourself a little pain in order to endure an ungodly pain later. Better to bite a washcloth.

I certainly hope that the biopsies of the growths do not necessitate further treatment, but rest assured, you are going through charted territory.

[tednlou2]

Sorry to hear you have to endure a surgery, but glad you were screened. 

For those following studies, what are the differences between the general public and those who have anal sex and/or HIV poz?  I know one doesn't have to have had anal sex, but it is the greatest factor, right? 

[PozBrian]

My clinic sent me a email, after they called me with the first set of result, that had a flyer attached that explained some things. Mostly the criteria used for HPV screening along with a little of what to expect. They flyer talked about anal pap smears, what it is, why it's done, and how it's done. It also talked about anal biopsies. It was pretty accurate however, I've progressed beyond the info in that flyer.

According to the flyer, an anal pap smear was recommended for HIV + people who met any one of five things, receptive anal sex, HPV infection, history of anal warts, Anal Dysplasia or an abnormal cervical pap smear. Needless to say I qualified for one of the five before the biopsy and now 3 of 5. joy.

Some of the reading I've done does talk about increase risk fo anal cancer for hiv+gay men. Anal cancer being somewhat rare and more specific to those hiv+ than colon cancer or rectal cancer. Did find this article on The Body. I'm sure there are others.
http://www.thebody.com/Forums/AIDS/Cancer/Q140978.html

[buginme2]

Hi, I have also been diagnosed with High Grade Anal Intraepithelial lesions (AIN 3).

One thing that bugs me about this topic is AIN is NOT the same thing as anal warts.  They are both caused by HPV but they are NOT the same thing.

I have been treated for this for about two years now.  Treatments can vary.  It really depends on how and what they treat you with.  There are some topical treatments they can use that you apply on your own such as Aldera and 5-FU cream.  Aldera isn't that bad (although some people have a bad reaction to it).  The 5-FU cream was a nightmare for me and I didn't make it through that treatment.

They can also apply acid directly to the cells, this just has a mild burning when they do it but its not that bad.

There is a procedure called Infrared Coagulation.  They zap the cells with some infra red laser thing.  It sounds worse than it is.  It's actually painless and no big deal.

Until they clear you will need to go in for anal paps and a High Resolution Anoscopy on a regular basis (ever 4 months so). Once they clear you will need to go in yearly. 

UCSF has a great website about anal dysplasia that has tons of info about it.

http://id.medicine.ucsf.edu/analcancerinfo/

Everyone who is HIV positive should be screened regularly with an anal pap and high resolution Anoscopy regardless if you are gay or not.  The HIV clinic I go to screens everyone.  I guess others don't do it, but since there are no symptoms of AIN (it's not the same thing as warts) you need to be screened regularly.

[jkinatl2]

Apologies if my attempts at commiseration were misconstrued.

[buginme2]

Apologies if my attempts at commiseration were misconstrued.

Didn't intend to negate your contribution. Sorry. This topic just seems to get me going since I have been struggling with trying to get it to clear for a couple years now.   There have been about a dozen threads on here about dysplasia and it seems that in every one someone posts about anal warts and after awhile you just want to yell "we are not talking about warts!!!." 

Anyway.  Not to derail.  To the op.  Dont worry, in most cases the dysplasia never progresses to cancer and with treatment it can be cleared.  Sometimes it just takes longer or trying more than one option.

I am concerned though about your referral to a surgeon immediately.  Are they going to try treatment first or are they going straight to surgery?   There are less invasive treatments such as the IRC and the many topical treatments.

You may also want to consider the HPV vaccine,  its not approved for treatment so it would be prescribed off label.  My doctor prescribed it for me when I was diagnosed with the AIN3, just a thought.

[PozBrian]

Thanks to all for the info. I go to see the surgen on the 29th so we'll see what she proposes. My dysplasia was actually found in an anal wart   so they might as well be the same for me. 

I'm not 100% sure of the technical diagnosis, (AIN 1,2,3 or whatever) Nor have I had a conversation about prognosis. That's on my list to ask about next week along with asking about the vaccine.

[PozBrian]

Today I went to the see the surgeon and she gave me a more complete information. Turns out what I have has been classified as AIN 3. Also my particular version of HPV is in the category of the more aggressive varieties. So it's an HRA in a month to cut out those bad cells away. Going to my ID Dr next month to have a fresh set of labs done before then. Seems like it will be pretty easy. One day, plenty of pain meds, and a few days off work and should be all.

I'm pretty happy with the aggressive treatment plan. The surgery plan is somewhat controversial but my DR's feel that it is better to get it quickly. (Still sounds like rotor rooter to me.)

I'm not sure how I feel about this overall. It's my first real health issue since test poz, even though as health issues go it isn't huge. It's huge enough for me. I knew this day would come, and now it has. Feeling a little nervous, and unsure. beyond that I'm not sure what.

[buginme2]

Sorry to hear about the AIN3 results.  Don't worry though its pretty common.  I just had another HRA yesterday.  Very simple procedure.

I am curious though, are they really doing surgery as your first treatment?  You may want a second opinion.  IRC (Infrared Coagulation) is simple and painless and zaps away the area affected with zero side effects.  Not to mention there are topical creams/ointments and acid treatments they can use.  Seems a bit drastic to start with surgery.  I've been treated for for over two years for the same thing and we haven't even discussed surgery yet. 

[PozBrian]

I think you've touched on the the controversy over surgery. I'm actually having an HRA. It's the General Surgery Clinic that does them. I may be overdoing a bit. I guess I'm worried about how effective it will be and what other things may result from this in the future.

[PozBrian]

Had those nasty over replicating cells cut out. Just feel a bit uncomfortable for now. Got lots of pain killers and stool softeners that should make things go better. The only glitch, if it is that, is that I have to fly to Japan on Saturday. I'll be working there for next week. Not looking forward to the flight from LA to Tokyo but at least Percocet puts me to sleep!