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 23, 2014, 06:53:17 PM

Login with username, password and session length


Members
Stats
  • Total Posts: 639876
  • Total Topics: 48581
  • Online Today: 220
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online
Users: 3
Guests: 152
Total: 155

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: High Rez Anoscopy  (Read 2727 times)

0 Members and 1 Guest are viewing this topic.

Offline buginme2

  • Member
  • Posts: 2,952
High Rez Anoscopy
« on: July 14, 2011, 02:32:51 PM »
So just back from my quarterly appt and been on meds for 7 months now.  CD4 has hit that 500 mark!!!! Ya very happy about that.  VL still UD.

Question:  My doctor states that at my clinic they do a high resoluntion anosopy on HIV patients every year.  Therefore, I am going to be scheduled for one shortly.  Kinda freaked out a little bit about it.  Not sure why.  I've never had an anal pap smear or anything like that so I'm not aware of any problems down there.  Not sure what they look for. 

Offline Miss Philicia

  • Member
  • Posts: 24,112
  • celebrity poster, faker & poser
Re: High Rez Anoscopy
« Reply #1 on: July 14, 2011, 02:47:37 PM »
If you've had a dick up your ass I fail to see a need to be apprehensive.
"Iíve slept with enough men to know that Iím not gay"

Offline buginme2

  • Member
  • Posts: 2,952
Re: High Rez Anoscopy
« Reply #2 on: July 14, 2011, 02:52:05 PM »
Touche'

I guess I just didn't realize it was a routine test.  I'll get over it. 

Offline Miss Philicia

  • Member
  • Posts: 24,112
  • celebrity poster, faker & poser
Re: High Rez Anoscopy
« Reply #3 on: July 14, 2011, 02:55:14 PM »
I wouldn't call it a routine test -- it should be a routine test, but in most places it is not yet.

You don't need to be apprehensive until and if they find high grade dysplasia, then they zap it with a laser and your ass bleeds for days, and your first couple attempts to shit are like giving birth.
"Iíve slept with enough men to know that Iím not gay"

Offline Tim Horn

  • Member
  • Posts: 799
Re: High Rez Anoscopy
« Reply #4 on: July 14, 2011, 02:55:42 PM »
Bug:

A lot of docs -- including mine -- don't believe in anal Paps, in light of the conflicting (read: limited) data indicating they're strong predictors of HPV-related abnormalities. Yet most HIV practices fully realize that anal cancers and pre-cancers are a huge problem, particularly among their gay/bisexual men and females with histories of cervical dysplasia, and are referring patients for direct visualization: Notably high resolution anoscopy, conducted and interpreted by proctologist or anal surgeons who definitely know what unhealthy tissue looks like and how to test it further.

Just because you've been referred for HRA by no means there's anything wrong... Your HIV doc simply wants to make sure there isn't anything wrong and, if abnormal tissue is found, that it is biopsied and, if necessary, treated.

Tim

Offline buginme2

  • Member
  • Posts: 2,952
Re: High Rez Anoscopy
« Reply #5 on: July 14, 2011, 03:04:44 PM »
Thanks, I think that may have been my concern.  Was curious why he bypassed the pap and went straight to the camera doohicky.  I had not heard of that before. 

 Its reassuring to hear that it should be routine,  makes me comfortable that my doc is on top of things.

Offline Jeff G

  • Administrator
  • Member
  • Posts: 11,812
  • How am I doing Beren ?
Re: High Rez Anoscopy
« Reply #6 on: July 14, 2011, 03:29:06 PM »
This topic has been on my mind for awhile now and I intend to address it at my next appointment with my ID doc .

I had an abnormal anal pap last year but when I was told the results were abnormal I was also told not to worry about it . It seems odd that they would test for something , find it , then ignore the results . I did ask about last visit and was told they would do another swab in a year . I have a copay for this stuff so if the pap test is not a reliable test I'm thinking I need to be scoped ... amiright ? .

 I guess my question on this topic is an abnormal pap smear should be fallowed up by a scope or its for naught ?   

Offline emeraldize

  • Member
  • Posts: 3,348
Re: High Rez Anoscopy
« Reply #7 on: July 14, 2011, 04:18:31 PM »
Hey Bug,

You're fortunate you're seen by a doc/clinic that can provide a High Resolution anoscopy.

Em

Offline Miss Philicia

  • Member
  • Posts: 24,112
  • celebrity poster, faker & poser
Re: High Rez Anoscopy
« Reply #8 on: July 14, 2011, 04:25:53 PM »
When I've brought this subject up at my LTS support group I've been met with blank stares. Not a single one of these guys has had it done. And no it's not due to lack of resources here -- I can think of two doctors they can go to off the top of my head. It's as much that HIV specialists aren't addressing the subject with patients.
"Iíve slept with enough men to know that Iím not gay"

Offline emeraldize

  • Member
  • Posts: 3,348
Re: High Rez Anoscopy
« Reply #9 on: July 14, 2011, 04:48:22 PM »
When I've brought this subject up at my LTS support group I've been met with blank stares. Not a single one of these guys has had it done. And no it's not due to lack of resources here -- I can think of two doctors they can go to off the top of my head. It's as much that HIV specialists aren't addressing the subject with patients.

I'm surprised especially given where you're located and the considerable literature available at this point. If someone were to make a presentation to your support group members do you think that would make a difference in their pursuing them?

edited to add:

NEW YORK (Reuters Health) - High-grade anal dysplasia is prevalent in HIV-positive gay men and high-resolution anoscopy is the best way to detect it, clinicians from Canada have found.

Squamous cell anal cancer is an uncommon malignancy, but one that is increasing in the general population. Currently, the rate is approximately 1 case per 100,000 people. However, HIV-positive men who have sex with men have a rate of approximately 60 cases per 100,000. In high-risk populations, screening for anal cancer and its precursor, high-grade anal intraepithelial neoplasia (AIN 2+), may be warranted, the researchers say in a May 1st online publication in AIDS.

Lead author Dr. Irving E. Salit from Toronto General Hospital and colleagues say that because anal cancer and cervical cancer have similarities -- both are human papillomavirus (HPV)-related and both are believed to develop from histologically similar precancerous dysplastic lesions -- methods used to detect cervical cancer may be effective for detecting anal cancer and are increasingly being used in high-risk populations.

This led the researchers to analyze the role of cytology and HPV testing in anal cancer screening in a cross-sectional study of 401 HIV-positive men who have sex with men. They studied all subjects with anal cytology, anal HPV tests, and high-resolution anoscopy (with anal biopsy if indicated).

The cohort (median age, 44 years) had been HIV-positive for a median of 14 years. The median CD4 cell count was 390 cells/microliter, and the median viral load was 50 copies/mL. About three quarters of subjects were on combination antiretroviral therapy. Only 31% had an AIDS-defining illness and only 18% had a CD4 cell count less than 200 cells/microliter.

Cytology was abnormal in 67% of patients, including 47 (12%) with high-grade squamous intraepithelial lesions (HSIL), 172 (43%) with low-grade squamous cell intraepithelial lesions (LSIL), and 49 (12%) with atypical squamous cells of undetermined significance (ASCUS).

Sixty-eight percent of patients had abnormal biopsies: AIN 2+ in 25% and AIN 1 in 43%. No invasive cancers were initially identified. HPV was detected in 93% of patients; 92% had multiple HPV types and 88% had oncogenic types.

With ASCUS as the threshold for ďabnormal,Ē the authors found that abnormal anal cytology predicted histologically confirmed AIN 2+ with a high sensitivity (84%) but low specificity (39%). Using oncogenic HPV, sensitivity was 100% and specificity 16%. The combination of any abnormal cytology and oncogenic HPV as a predictor of AIN 2+ yielded "minimal improvement" in test performance compared with cytology alone (sensitivity 84% vs 84% and specificity 43% vs 39%).

In e-mail to Reuters Health, Dr. Salit offered the following take home messages: "To screen for anal pre-cancers in a high-risk population (like ours), HPV detection is too expensive and too frequently positive to be useful. Anal Pap smears could be done first; however abnormal anal Pap smears are non-specific unless the result shows high-grade changes. That result usually means true high grade pre-cancer inside."

"It is best," he concludes, "to go right to high-resolution anoscopy if the machine and expertise are available. If not, screen with Pap smear first."

Reference:
AIDS 2010.
« Last Edit: July 14, 2011, 04:55:44 PM by emeraldize »

Offline buginme2

  • Member
  • Posts: 2,952
Re: High Rez Anoscopy
« Reply #10 on: July 14, 2011, 07:00:31 PM »
"It is best," he concludes, "to go right to high-resolution anoscopy if the machine and expertise are available. If not, screen with Pap smear first."

Thanks for the info!

Offline emeraldize

  • Member
  • Posts: 3,348
Re: High Rez Anoscopy
« Reply #11 on: July 14, 2011, 08:34:28 PM »
You're most welcome.

Offline edfu

  • Member
  • Posts: 1,084
Re: High Rez Anoscopy
« Reply #12 on: July 15, 2011, 05:05:59 AM »
I guess my question on this topic is an abnormal pap smear should be fallowed up by a scope or its for naught ?  

Yes, absolutely.  An abnormal pap smear should be followed up with a high-resolution anoscopy.   I fail to understand the purpose of having another pap smear done after a previous pap smear indicated abnormalities.  You'll just get another abnormal result.  The HRA--and possible biopsies as indicated--will clarify the exact nature of the problem and how serious or not it might be.  
« Last Edit: July 15, 2011, 05:15:31 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 bocker3

  • Member
  • Posts: 3,388
  • You gotta enjoy life......
Re: High Rez Anoscopy
« Reply #13 on: July 18, 2011, 07:58:03 PM »
Remember -- a pap smear is simply a screening test.  Most screening tests are designed to be very sensitive, yet not overly specific ==>  translation:  you should see a fair number of false positives (and, one hopes, very few false negatives).  A positive screening test should be followed up with a more sensitive test -- like the HRA -- the results of that should indicate next steps (I would never have a biopsy done off of a screening test result).

I talked with my ID doc about anal paps -- he wasn't opposed, but wasn't impressed either.  I then spoke with my colo-rectal surgeon (he who removed my internal warts a couple of times).  He did not like paps at all -- he would rather I come in yearly and have him give me a once over with the anoscope.  I like that approach and see him each year (sometimes more often when those damned warts come back).  As he says to me -- I know what a normal "bottom" looks like - he never calls an ass anything but a bottom (though I have met many bottoms who were asses....)

Mike
Atripla - Started 12/05
Reyataz/Norvir - Added 6/06
Labs - Pre-Meds
Sep05 T=350/25% VL98,559
Nov05 288/18%  47,564
Current Labs
May2013 691/31% <20

Offline buginme2

  • Member
  • Posts: 2,952
Re: High Rez Anoscopy
« Reply #14 on: July 18, 2011, 08:03:15 PM »
Thanks for your post Bocker.  From what it sounds like based on my clinics reccomendation as well as your dr's and others on here, the high rez anoscopy each year is not only appropriate but probably a better option that a pap smear. 


Offline buginme2

  • Member
  • Posts: 2,952
Re: High Rez Anoscopy
« Reply #15 on: January 05, 2012, 07:18:28 PM »
I finally got the letter today scheduling my appointment at the anal dysplasia clinic.  Cant beleive it took 6 months.  So I'm finally scheduled for this thing.  I guess every January from now on I get to look forward to a bum exam!! I'm excited  ;D

 


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.