Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
September 19, 2014, 08:00:10 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 639488
  • Total Topics: 48541
  • Online Today: 218
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: Has anyone used Imiquimod or another preparation for Anal Dysplasia?  (Read 6869 times)

0 Members and 1 Guest are viewing this topic.

Offline Tempeboy

  • Member
  • Posts: 358
  • Like St Francis of Assisi I am wedded to Poverty
Just had an 'anoscopy' (ick!) and have High Grade Anal Dysplasia - on top of everything else.

I am considering my treatment options and would really appreciate any information from others experiences.

TB
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline surf18

  • Member
  • Posts: 525
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #1 on: March 03, 2011, 06:57:49 PM »
i dont know if thats a fancy word for butt warts but thats what i used that cream for. it sucked shit. but it was better than butt wart surgery i ended up having a month ago. the skinny on the cream is that it works, you gotta use it every other day for sixteen weeks. you must wipe it off ,clean it off every morning . the cream at some point will give you butt irritation.where your butt burns like a mother. but that is still way better than the surgery pain. the cream works best on warts that are on the exterior , but the interior like where they did the scope it wont work up there.

Online leatherman

  • Member
  • Posts: 6,192
  • Google and HIV meds are Your Friends
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #2 on: March 03, 2011, 07:14:06 PM »
a word of caution, as one who recently tried Imiquimod - about 4% of users have a bad reaction to this medication. because the cream actually stimulates an unnatural immune response, some people have had a serious reaction resulting in autoimmune illness.

As for myself, after 2 applications I became incredibly ill. (lordy! I thought I had aids again. it was scary!) By the 5th application I was afraid, like in other personal stories I have since read online, that I was doing serious damage to my immune system and stopped this treatment. It took 8 days after the last application to feel as if I have recovered from using this cream. Be very cautious if you experience any flu like symptoms (fever, fatigue, nausea, diarrhea). I'm getting a referral from my clinic tomorrow for surgery and can't wait for that option compared to the effects of Aldara/Imiquimod.

definitely read HPV and anal cancer. then do an advanced search here for "HPV" and the user "Edfu" and you'll find tons of information about this topic.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Online Miss Philicia

  • Member
  • Posts: 24,104
  • celebrity poster, faker & poser
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #3 on: March 03, 2011, 07:20:02 PM »
Anal warts and high grade anal dysplasia are not the same thing.
"Iíve slept with enough men to know that Iím not gay"

Offline J.R.E.

  • Member
  • Posts: 7,161
  • Joined Dec-2003 Living positive, since 1985.
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #4 on: March 03, 2011, 07:25:58 PM »
Hey..

I've used it before ( Aldara Cream),  for external warts, and it did work to some degree, but eventually, I still had to go under anesthesia, and have them surgically removed.

As I understand it, Aldara is not to be used internally, in the rectum.  I didn't have the response that Mike had, but he is right, it works by activating your immune response.


http://www.medicinenet.com/imiquimod-topical/article.htm


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline J.R.E.

  • Member
  • Posts: 7,161
  • Joined Dec-2003 Living positive, since 1985.
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #5 on: March 03, 2011, 07:30:22 PM »

I wanted to add, that I also used podifilox solution.  Once again there were some good results, but still didn't do the job.

http://www.aidsmeds.com/articles/HPV_6805.shtml


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Online Miss Philicia

  • Member
  • Posts: 24,104
  • celebrity poster, faker & poser
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #6 on: March 03, 2011, 07:38:06 PM »
Again, the OP had an anoscopy and has high grade anal dysplasia -- this has nothing to do with external anal warts, or even internal ones, except that warts are but one of the risk factors for having anal dysplasia.
"Iíve slept with enough men to know that Iím not gay"

Online leatherman

  • Member
  • Posts: 6,192
  • Google and HIV meds are Your Friends
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #7 on: March 03, 2011, 07:55:25 PM »
Again, the OP had an anoscopy and has high grade anal dysplasia -- this has nothing to do with external anal warts, or even internal ones, except that warts are but one of the risk factors for having anal dysplasia.
since you seem to know about this subject, is Imiquimod used in the treatment of hg anal dysplasis at all or is the OP's basic question off the mark then? Most of the responses here are directly to the subject of this thread rather than to the issue of anal dysplasia per se.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline J.R.E.

  • Member
  • Posts: 7,161
  • Joined Dec-2003 Living positive, since 1985.
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #8 on: March 03, 2011, 08:11:13 PM »
Again, the OP had an anoscopy and has high grade anal dysplasia -- this has nothing to do with external anal warts, or even internal ones, except that warts are but one of the risk factors for having anal dysplasia.

Yep,  I got sidetracked from a different response in this thread.  This is why I posted the second link from the lessons dealing with :

Human Papilloma virus,  HPV genital warts, " Anal , Cervical Dyslpasia/cancer :


http://www.aidsmeds.com/articles/HPV_6805.shtml


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Online Miss Philicia

  • Member
  • Posts: 24,104
  • celebrity poster, faker & poser
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #9 on: March 03, 2011, 08:14:09 PM »
since you seem to know about this subject, is Imiquimod used in the treatment of hg anal dysplasis at all or is the OP's basic question off the mark then? Most of the responses here are directly to the subject of this thread rather than to the issue of anal dysplasia per se.

1) the issue is anal dysplasia -- read the thread title, he didn't say "anal warts"

2) I offered no comment about Aldara for treatment of high grade anal dysplasia because last time I had high grade anal dysplasia treated (in 2004) I don't believe it was yet on the market.

3) When I was treated seven years ago laser surgery was employed.  As far as I know that is still the standard that my doctor for this issue uses.

4) I have only heard of Aldara being used for external genital and perianal warts (i.e. anal warts). At least as of 2009 the prescribing information clearly stated that it was NOT to be used internally.  If that has changed let me know, since you just said you were prescribed it.  I do know that some doctors have prescribed it if the warts are not far in the anus, but as of two years ago that was clearly off-label and not enough data to confirm a recommendation.  Similarly with anal dysplasia, which is this thread's topic in conjunction with Aldara, as far as I know there has only been one small study of 58 people and, while promising, that's obviously not a great data set to go off of and I'd be suspicious of a doctor making that recommendation personally.

So I'm curious Mikie, did you use Aldara for external warts, internal warts or for high grade anal dysplasia as a result of an anoscopy examination?
"Iíve slept with enough men to know that Iím not gay"

Offline J.R.E.

  • Member
  • Posts: 7,161
  • Joined Dec-2003 Living positive, since 1985.
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #10 on: March 03, 2011, 08:28:24 PM »


I think when the OP used "Imiquimod" ( Aldara) In the thread title, is where my confusion started.


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Online leatherman

  • Member
  • Posts: 6,192
  • Google and HIV meds are Your Friends
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #11 on: March 03, 2011, 08:50:18 PM »
1) the issue is anal dysplasia -- read the thread title, he didn't say "anal warts"
the title reads "Has anyone used Imiquimod or another preparation for Anal Dysplasia?" so the OP was specifically asking about Imiquimod or another preparation as treatment for his condition. I initially assumed that because the OP posted about this medication along with his condition that he and his doctor had discussed this as an option.

Since you seemed intent on repeating that this was not a thread about anal warts (though surf was the only one besides you to talk about warts), I thought perhaps you knew more and knew that Imiquimod would not be used as a treatment for anal dysplasia - and so I asked for your opinion. Am I correct then in assuming by your response #4, that this cream would NOT be used for the condition and that the OP is wrong in even considering this treatment for his condition?

Since I have not been diagnosed with dysplasia (but might very well have that problem. I'll know more now that my clinic is giving me a referral to a specialist after my reaction to this medication), I wanted to know your more knowledgeable opinion, for the OP's and my edification.

However since the OP asked about this specific medication, because I have had experience with this medication and because I recently learned a lot about this medication because of my negative reaction and side effects, I offered my warning, as I have found that this cream is frequently prescribed without people/doctors/nurses understanding that 4% of people have such bad reactions. Because of what I've learned, I still give a word of caution to the OP that if Imiquiod is prescribed for his condition that he be aware of the seriousness of flu-like symptoms associated with this medication.
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline edfu

  • Member
  • Posts: 1,084
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #12 on: March 04, 2011, 11:32:44 PM »
Imiquimod (U.S. brand name:  Aldara) is currently approved in the U.S. for treating actinic Keratosis (pre-malignant lesion on sun-exposed skin), superficial basal-cell carcinoma (a type of skin cancer), and external genital warts (caused by HPV).  It is not approved for internal warts in the anal canal, and it is not a cure for HPV itself. 

Aldara is an immune-response modifier; it stimulates the production of interferon-alfa and pro-inflammatory cytokines.  This may be why there is a warning about its use in those with "weakened" immune systems, and its safety and efficacy in those has not been established.  PLWHA do not want any increase in interferon and cytokine production. 

The AIDSmeds.com fact sheet on HPV clearly states that Aldara should not be used internally for warts or for treating anal dysplasia:

"Topical medications: Topical gels and creamsósuch as podofilox, podophyllum, trichloroacetic acid, and imiquimodóare used only for the treatment of genital warts. In general, they have shown to be 30% to 80% effective in reducing wart size, sometimes dramatically. All topical treatments, with the exception of imiquimod, can be used to treat warts inside the anus or vagina. They are not effective for the treatment of anal or cervical dysplasia or cancer."

If Aldara is recommended by physicians for internal anal warts, it would be an off-label usage.  The safety and efficacy of this are unknown.  It must be noted that it's quite easy to Google patient evaluation of Aldara usage, and there are quite a lot of very negative opinions out there.  Side effects can be quite horrific for all of its approved uses.  To mitigate these, it is always recommended to use Aldara sparingly and to apply it quite specifically to only affected  areas and not to any adjacent skin.  How this can be done for internal usage is a mystery to me, since even the assistance of a mirror or a friendly applicator would be null. 

The use of Aldara for anal dysplasia is even further off-label.  As Miss P has already pointed out, there has been only one very small study, in the U.K., first reported last August:

http://www.aidsmap.com/Imiquimod-a-good-treatment-for-pre-cancerous-anal-lesions-in-men-with-HIV/page/1507497/

I've been unable to find any other such studies in the literature.  I was stunned in August,  and remain so, that not a single participant withdrew because of side-effect issues.  This is very difficult to believe.  Also, anal dysplasia and anal cancer is a squamous-cell carcinoma issue, another type of skin cancer.  Aldara can be used for minor external basal-cell carcinoma, but I am uncertain whether identical chemotherapies can be used for both basal-cell and squamous-cell carcinomas. 

It does appear that some oncologists are recommending the off-label use of Aldara for anal dysplasia, but how common this may be is unknown.  I discovered Levi's Cancer Blog on a cancer-support site.  Levi, who is HIV-positive, has already undergone the removal of a large head tumor, necessitating some extensive facial reconstruction, and now has been diagnosed with anal cancer.  He reports that one of his oncologists at M.D. Anderson Hospital, in Houston, recommended Aldara.  However, if you follow his updates, it appears that, sadly, it doesn't appear to be working:

http://levi.blogforacure.com/weblog/2011/01/11/0001

As I have pointed out several times on AIDSmeds.com, the lack of standardization of medical diagnosis and treatment of HPV and anal cancer and the lack of essential research are tragic.  This deficiency, I am convinced, will only become worse as the incidence of anal dysplasia and cancer continues to increase in the PLWHA community.       

"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline Tempeboy

  • Member
  • Posts: 358
  • Like St Francis of Assisi I am wedded to Poverty
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #13 on: March 16, 2011, 07:36:50 PM »

Thanks to all,

Going for my follow up appointment on monday - not looking forward to it.  It was only picked up by chance when I was asked by a colleague to participate in a local study, the SPANC study.

http://www.nchecrsurveys.unsw.edu.au/spanc/

I have read a couple of articles about internal Imiquimod treatment, which I would be happy to try.  I would love to hear about laser treatment and other successful interventions that people have used.

TB

Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Online Miss Philicia

  • Member
  • Posts: 24,104
  • celebrity poster, faker & poser
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #14 on: March 20, 2011, 09:31:50 AM »
I would love to hear about laser treatment and other successful interventions that people have used.


I had laser treatment once (is the medical term "infrared coagulation" I think... do you recall Edfu?) -- really it wasn't as huge of an ordeal for me as I thought it might be, but then I'd previously had anal warts surgicallyremoved so I was a little more prepared for an attack on my anus.  My doctor prescribed me some xanax to take before the treatment which is helpful.  Basically you're just up on a table, maybe in stirrups (can't clearly recall) and they just go in and zap the lesion.  I would have the treatment done on a Friday afternoon so you have the weekend to recoup, and the recoup for me was just some periodic anal bleeding.  Nothing gushing, but it was recommended that I buy some "feminine protection" padding to wear in my underwear, and I also put towels on my bed so as not to ruin my sheets.  I also took hydrocodone after the treatment.  Your first bowel movement is memorable, and maybe the second one too, but after that you're OK.  I think I was advised not to have anal sex for two weeks, or something like that.

Oh, and I might be participating in an upcoming clinical study of HIV and anal intraepithelial neoplasia issues, though I don't know the details yet.  I had my 4-month HIV appointment last week and my physician mentioned the possibility but will know more at my next appointment.
« Last Edit: March 20, 2011, 09:37:44 AM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline edfu

  • Member
  • Posts: 1,084
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #15 on: March 21, 2011, 01:46:25 AM »
I had laser treatment once (is the medical term "infrared coagulation" I think... do you recall Edfu?)

Laser therapy and IRC (infrared coagulation) are similar in their general principles of activation but are entirely different in the individual specifics of  their application.  They're two really different surgical interventions.  Laser uses a highly intense light stream to kill abnormal cells.  IRC uses an intense beam of infrared light and radiation.  The heat from IRC is at a lower range than that used in laser or in electrocautery (or electrofulguration), which uses an electric current  (via an electric needle) and is a third method of surgical intervention.  

All three methods have their pluses and minuses, and no method has been declared the standard of care.   Individual response and personal preference are important.  Recurrence is a major problem with each.  IRC can be performed outside of a hospital setting and does not usually require general anesthesia.

The real problem is finding a colorectal doctor who administers the surgery and understands the connection between HPV and HIV, let alone finding one who offers all of the alternatives.    
« Last Edit: March 21, 2011, 04:18:58 AM by edfu »
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

Offline Obergine

  • member
  • Posts: 1
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #16 on: October 19, 2011, 11:10:25 PM »
Old post but only one on this topic so my $.02.
I've been treated for anal dysplasia (high-grade- the cancer-linked type) with IRC (InfraRedCoagulation) for 2.5 years.  Finally got the high-grade under control (?) but low-grade continues, so my IRC Dr put me on imiquimod, dosed at 3x per week for 4 months.
First treatment- ALL SIGNS OF HPV GONE!  But had a splitting headache for two days, until next treatment.
2nd treatment- No signs of side-effects and headache less.
3rd treatment- No signs of trouble.... But the next day, my anus is on fire and has stayed so for 5 days.
No further use planned for me, unless I have a recurrance.
This med is way off-label for anal dysplasia, but thought I'd try.  I'm fairly disgusted that my Dr did ZERO warning/cautions for its use.  Treated it casually, like skin cream.  This med should be warned, warned and warned again before prescribing, and no dosing should ever be "use 3x weekly for 4 months".
Since it cleared all signs of HPV/anal dysplasia with a single dose, I think any dose after that should be done with extreme caution.
I will be talking with my Dr re: all of this. 
HIV POZ= 1987
HAART= Isentress, Selzentry, Truvada since 2007
CD4= ~ 250-300
Viral Load= Undetectable
Opportunistic Infections:
Non-Hogkins Lymphoma(2008-'cured')
HPV-HighGrade Anal Dysplasia(2009-Current. Treatments= IRC & Imiquimod)
General Health= Good

Online leatherman

  • Member
  • Posts: 6,192
  • Google and HIV meds are Your Friends
Re: Has anyone used Imiquimod or another preparation for Anal Dysplasia?
« Reply #17 on: October 19, 2011, 11:28:47 PM »
I'm fairly disgusted that my Dr did ZERO warning/cautions for its use.  Treated it casually, like skin cream.  This med should be warned, warned and warned again before prescribing, and no dosing should ever be "use 3x weekly for 4 months".
...
I will be talking with my Dr re: all of this. 
my doc was incredibly surprised by how sick I got using this cream - and still is, months later, when we discussed this a few weeks ago. After two weeks of hell using this cream and reading a lot on the internet, I learned that a very, very small percentage of users (like 1% or less) have incredibly horrible side effects to Imiquimod. Still to this day when we discuss this matter, my doctor is quick to tell me how often this is prescribed and how often there are wonderful results (oh I got good results too but think that feeling like you have AIDS all over again is too huge price to pay to get rid of a few warts. Give me the surgery any damned day. LOL)

Hope you're doing okay now, and hopefully this thread will help some people know they're not crazy when they get terribly sick using this commonly prescribed cream.  ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.