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.
April 23, 2014, 11:47:22 AM

Login with username, password and session length


Members
  • Total Members: 22247
  • Latest: d18p
Stats
  • Total Posts: 621140
  • Total Topics: 46785
  • Online Today: 267
  • 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: Have you had your HRA yet this year?  (Read 3181 times)

0 Members and 1 Guest are viewing this topic.

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Have you had your HRA yet this year?
« on: September 26, 2013, 06:05:01 PM »
I had my HRA last week and for the first time in three years they couldn't visually see any areas that needed treatment!! And, the pap for the first time didn't show high grade dysplasia!  It did show ASCUS but that's better than AIN3 which is what every pap and HRA I have had has showed (I think I've had 6 or 7 and have gone through just about every treatment available).

After my exam I was speaking with the HRA doctor and we got into a very long conversation about how many patients they lose to follow up each year.  Apparently, it's a lot.  So I just want to put out a friendly reminder that if you haven't had an anal pap and HRA this year you should schedule one.  All HIV positive men and women should have them done once per year (more if they find dysplasia). 

"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline WillyWump

  • Member
  • Posts: 7,032
Re: Have you had your HRA yet this year?
« Reply #1 on: September 26, 2013, 06:21:49 PM »
So I just want to put out a friendly reminder that if you haven't had an anal pap and HRA this year you should schedule one.  All HIV positive men and women should have them done once per year (more if they find dysplasia). 



 I get a yearly Pap, which have all been good so far,  but have never had an HRA. Is this something I should be asking for?

-W
POZ since '08

Last Labs-
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%
8/9/12, CD4 not taken, UD.
2/13/12, CD4- 904, UD 42%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #2 on: September 26, 2013, 06:33:51 PM »
I get a yearly Pap, which have all been good so far,  but have never had an HRA. Is this something I should be asking for?

-W

I think the benefit of the HRA is that the pap doesn't catch everything and the dr wants to visually look to see if there are any changes.  They take screen shots and compare them with previous ones to measure if there have been changes.   The med center where I go does them both together.   They do HRA yearly if you have no issues, more if there is a problem.
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline weasel

  • Member
  • Posts: 1,588
Re: Have you had your HRA yet this year?
« Reply #3 on: September 26, 2013, 07:12:10 PM »
I had my HRA last week and for the first time in three years they couldn't visually see any areas that needed treatment!! And, the pap for the first time didn't show high grade dysplasia!  It did show ASCUS but that's better than AIN3 which is what every pap and HRA I have had has showed (I think I've had 6 or 7 and have gone through just about every treatment available).

After my exam I was speaking with the HRA doctor and we got into a very long conversation about how many patients they lose to follow up each year.  Apparently, it's a lot.  So I just want to put out a friendly reminder that if you haven't had an anal pap and HRA this year you should schedule one.  All HIV positive men and women should have them done once per year (more if they find dysplasia).

  What is an HRA ? 

                                                                       Carl
" Live and let Live "

Online Miss Philicia

  • Member
  • Posts: 23,577
  • celebrity poster, faker & poser
Re: Have you had your HRA yet this year?
« Reply #4 on: September 26, 2013, 08:24:55 PM »
I have a high-resolution anoscopy every year. My last one was in April.
"Iíve slept with enough men to know that Iím not gay"

Offline friskyguy

  • Member
  • Posts: 104
Re: Have you had your HRA yet this year?
« Reply #5 on: September 26, 2013, 08:35:02 PM »
this is great advice.......I get mine done every 12-18mths.

Making an appointment compared to the thought of wearing a colostomy bag or to die in the future from cancer is an easy decision for me!!
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline tednlou2

  • Member
  • Posts: 4,613
Re: Have you had your HRA yet this year?
« Reply #6 on: September 26, 2013, 11:22:10 PM »
I can't find any doc doing anal paps here.  I assume most colorectal docs can do the HRA?

Offline Jeff G

  • Global Moderator
  • Member
  • Posts: 9,368
  • How am I doing Beren ?
Re: Have you had your HRA yet this year?
« Reply #7 on: September 26, 2013, 11:39:02 PM »
  I assume most colorectal docs can do the HRA?

Not so ... many city's large and small are slow to offer this beneficial test .

Offline phildinftlaudy

  • Member
  • Posts: 2,950
  • sweet Ann what you think babe...
Re: Have you had your HRA yet this year?
« Reply #8 on: September 27, 2013, 12:03:53 AM »
Just looked it up w/ Aetna (my employer-paid insurance) - this is what Aetna's Clinical Policy Bulletin says in regards to the procedure and them covering, or should I say in most cases not covering, the procedure:

Aetna considers high-resolution anoscopy (HRA) medically necessary for the diagnosis of a suspicious anal lesion in persons with abnormal anal physical findings (e.g., anogenital warts, hypo-pigmented or hyper-pigmented plaques/lesions, lesions that bleed, or any other lesions of uncertain etiology).
 
Aetna considers HRA guidance medically necessary for biopsy and ablation of high-grade anal intraepithelial neoplasia.

Aetna considers HRA experimental and investigational for screening of asymptomatic persons for anal dysplasia and anal cancer.

So, basically they won't cover it unless there are some type of precipitating symptoms.....otherwise, they feel it is experimental.... they provide a host of research citations to back up why they don't cover it if one is asymptomatic and only cover with CPT codes that cover indications for the procedure that they list in the Clinical Policy Bulletin (CPB)

http://www.aetna.com/cpb/medical/data/800_899/0808.html


So, in order for me to get this done - my doc would have to be able to justify it w/ one of the CPT codes in the bulletin....
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #9 on: September 27, 2013, 12:11:50 AM »
Phil I have Aetna and have never had an issue with them covering it and I didn't have any precipitating symptoms.  I assume that each plan is different and it may depend on what your employer has selected to cover???   

They even paid for the HPV vaccine for me and that's not even approved for people my age. 
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Online Miss Philicia

  • Member
  • Posts: 23,577
  • celebrity poster, faker & poser
Re: Have you had your HRA yet this year?
« Reply #10 on: September 27, 2013, 12:22:49 AM »
I've been getting these for over a decade now, and have never had either private insurance or Medicare balk at covering the procedure. However, I did have a PAP smear first which showed abnormal cell structures so I'm sure that's why.

And any GP can do a PAP smear. All it is is a large q-tip that goes up your ass and is then sent to a lab. I don't understand why yearly this comes up, at least with the PAP smear.

Furthermore, if you can't find a colorectal surgeon where you live with the facility to do HRA they can indeed to a regular anoscopy, it's just not high resolution.
« Last Edit: September 27, 2013, 12:24:52 AM by Miss Philicia »
"Iíve slept with enough men to know that Iím not gay"

Offline phildinftlaudy

  • Member
  • Posts: 2,950
  • sweet Ann what you think babe...
Re: Have you had your HRA yet this year?
« Reply #11 on: September 27, 2013, 12:29:25 AM »
Phil I have Aetna and have never had an issue with them covering it and I didn't have any precipitating symptoms.  I assume that each plan is different and it may depend on what your employer has selected to cover???   

They even paid for the HPV vaccine for me and that's not even approved for people my age.

Given my history - and particularly being HIV+, I'm sure my doctor could get it approved - but she would probably have to get pre-authorization for it......Aetna has covered every other procedure I have had done - although, there have been a couple of times where they denied things until they received more information from the doc.... such as when I had a larnoscopy (spelling incorrect) and when I had a scope put into my knee (or some type of thing to guide them for the cortisone injection) - I also had to get pre-auth for my upper and lower GI because they do mine every three years due to previous findings.... but, in the end, they have always paid...

I will have to mention the HRA and, at a minimum, the PAP to my ID doc when I see her October 16th. I've never had a PAP done - Shit (pardon the pun) - I don't even know when the last time was that my doc even looked at my ass.   :(

BTW, latest labs show 987 cd4, but triglycerides are up to 260 - so, she won't be happy about that... I also have to check on these readings for my "natural killer cells" - % CD16+CD56 (NATURAL$KILLER CELLS). They are supposed to be between 4 - 25%, but mine have been 3% and 4% over the past couple of labs (but I don't really know what they relate to).
« Last Edit: September 27, 2013, 12:32:19 AM by phildinftlaudy »
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline tednlou2

  • Member
  • Posts: 4,613
Re: Have you had your HRA yet this year?
« Reply #12 on: September 27, 2013, 02:07:49 AM »
I've been getting these for over a decade now, and have never had either private insurance or Medicare balk at covering the procedure. However, I did have a PAP smear first which showed abnormal cell structures so I'm sure that's why.

And any GP can do a PAP smear. All it is is a large q-tip that goes up your ass and is then sent to a lab. I don't understand why yearly this comes up, at least with the PAP smear.

Furthermore, if you can't find a colorectal surgeon where you live with the facility to do HRA they can indeed to a regular anoscopy, it's just not high resolution.

My family doc wouldn't even check my complaint of possible hemorrhoids or fissure.  He said he doesn't do that.  I haven't seen him since, I don't think.  I told a few friends and was surprised a few said their family doc wouldn't either.  They said their doc just referred them to a colorectal doc.  That seems so ridiculous to me.  I guess some docs just want to write prescriptions and get you out within 5 mins.  I was beginning to think it was HIV that caused him to refuse.  I was already paranoid, when they stopped taking my temp after always doing so before--which is usually standard whenever you see any doc. 

I had an anoscopy.  Doc said looked very nice.  Well, said there were some internal hemorrhoids, but said many have those. 

Offline aaware72

  • Member
  • Posts: 199
Re: Have you had your HRA yet this year?
« Reply #13 on: September 27, 2013, 02:30:58 AM »
I had one done last week and they took another biopsy.  Waiting on results.  I had my last one 6 month ago and had a low grade lesion last time.  He mention it looked better than it did last time.  My ID did the HRA
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #14 on: September 27, 2013, 02:31:12 AM »
My family doc wouldn't even check my complaint of possible hemorrhoids or fissure.  He said he doesn't do that.  I haven't seen him since, I don't think.  I told a few friends and was surprised a few said their family doc wouldn't either.  They said their doc just referred them to a colorectal doc.  That seems so ridiculous to me.  I guess some docs just want to write prescriptions and get you out within 5 mins.  I was beginning to think it was HIV that caused him to refuse.  I was already paranoid, when they stopped taking my temp after always doing so before--which is usually standard whenever you see any doc. 

I had an anoscopy.  Doc said looked very nice.  Well, said there were some internal hemorrhoids, but said many have those.

Do you see a private doc or do you go to a clinic/medical center?

I'm a fan of larger med centers that offer many specialties under one roof.  It makes things so much easier.  My HIV doctor doesn't do my HRA/pap.  It's done in the "digestive disease center" but it's all at the same place (in a clinic that is attached to one of the local hospitals).

I checked online and the university of Louisville has an HIV clinic called the Wings Clinic.  They have to be doing paps.  I'm sure at least they would take your temperature.

Side note: since doing an anal pap requires sticking a large q-tip up your ass as miss p explained its a great time to have a complete std check.  They usually do all of that at the same time so you end up taking care of everything at once.
« Last Edit: September 27, 2013, 02:45:46 AM by buginme2 »
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline tednlou2

  • Member
  • Posts: 4,613
Re: Have you had your HRA yet this year?
« Reply #15 on: September 27, 2013, 03:26:21 PM »
Do you see a private doc or do you go to a clinic/medical center?

I'm a fan of larger med centers that offer many specialties under one roof.  It makes things so much easier.  My HIV doctor doesn't do my HRA/pap.  It's done in the "digestive disease center" but it's all at the same place (in a clinic that is attached to one of the local hospitals).

I checked online and the university of Louisville has an HIV clinic called the Wings Clinic.  They have to be doing paps.  I'm sure at least they would take your temperature.

Side note: since doing an anal pap requires sticking a large q-tip up your ass as miss p explained its a great time to have a complete std check.  They usually do all of that at the same time so you end up taking care of everything at once.

The WINGS Clinic (now the 550 Clinic, named for the address) is where I get treatment.  They aren't doing anal paps.  But, checking my butt was one of the first things they did.  But, just taking a look at it with the eye. 

Online Miss Philicia

  • Member
  • Posts: 23,577
  • celebrity poster, faker & poser
Re: Have you had your HRA yet this year?
« Reply #16 on: September 27, 2013, 03:37:43 PM »
So then instead of complaining about this annually why don't you just go see a colorectal specialist?

I'd fire any GP who treats HIV patients and can't stick a damn q-tip up their patients pooper. Something here isn't adding up.
"Iíve slept with enough men to know that Iím not gay"

Offline Jeff G

  • Global Moderator
  • Member
  • Posts: 9,368
  • How am I doing Beren ?
Re: Have you had your HRA yet this year?
« Reply #17 on: September 27, 2013, 03:40:54 PM »
I actually took pity on my doctor the last time the Q tip came out for the old shove and swab session and did the ring around the rosy myself ... I made her watch though .

Online bocker3

  • Member
  • Posts: 3,265
  • You gotta enjoy life......
Re: Have you had your HRA yet this year?
« Reply #18 on: September 27, 2013, 03:42:53 PM »
I actually took pity on my doctor the last time the Q tip came out for the old shove and swab session and did the ring around the rosy myself ... I made her watch though .
Putting a cottonball on the end of a Jeff Stryker dildo does not, a q-tip, make.............   just sayin'
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 Jeff G

  • Global Moderator
  • Member
  • Posts: 9,368
  • How am I doing Beren ?
Re: Have you had your HRA yet this year?
« Reply #19 on: September 27, 2013, 03:44:23 PM »
Putting a cottonball on the end of a Jeff Stryker dildo does not, a q-tip, make.............   just sayin'

True

Offline WillyWump

  • Member
  • Posts: 7,032
Re: Have you had your HRA yet this year?
« Reply #20 on: September 27, 2013, 09:40:31 PM »
What's all this talk about Q-tips? Everytime I get a pap it it feels like she is scraping barnacles off my insides with a brillo. Something ain't right down here.

POZ since '08

Last Labs-
6/25/13 CD4- 1036, UD,
2/4/13, CD4 - 489, UD, 28%
8/9/12, CD4 not taken, UD.
2/13/12, CD4- 904, UD 42%

Current Meds: Prezista/Epzicom/ Norvir
.

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #21 on: September 28, 2013, 02:04:09 PM »
What's all this talk about Q-tips? Everytime I get a pap it it feels like she is scraping barnacles off my insides with a brillo. Something ain't right down here.

Barnacle Billy
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline edfu

  • Member
  • Posts: 1,084
Re: Have you had your HRA yet this year?
« Reply #22 on: September 28, 2013, 08:50:51 PM »
I can't find any doc doing anal paps here.  I assume most colorectal docs can do the HRA?

Most colorectal docs do NOT do HRA.  Most docs, in general, do not even do anal paps; they claim they haven't been trained to do them (although they can easily learn from watching a video on the Internet) and falsely claim that labs don't know how to analyze them. 

My last Pap was done by a doctor who moved his practice out of the area, and my last HRA, three years ago, was done by a doctor who has since retired and insisted that I had to be admitted to a hospital for him to do it.
Since then, I haven't been able to find a single doctor in the whole state of Connecticut who performs HRA's--not even in the Yale-New Haven medical complex.  I don't need another Pap; the last one showed I needed to be examined further with an HRA, and my last HRA confirmed that I do indeed need to be carefully watched.  The only alternative is to have it done in NYC, but my insurance won't cover it out of state. 

I know from research that this problem is not unique.     
"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 buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #23 on: September 29, 2013, 08:25:45 AM »
Reading about the difficulties ted and edfu are having finding someone to do a pap and HRA is a bit discouraging. 

I never had and signs or symptoms that something was wrong.  I've never had a wart or bleeding or anything that you would contribute to HPV infection.  If it wasn't for the automatic screening the clinic did I would have never known something was up.  When they first screened me I had some pretty advanced disease.  The treatments have been pretty thorough, some non invasive and others which were definitely not fun and some experimental.  I just worry had I not been screened what would have happened.  I'm still not completely clear oft he infection and it can still progress and anal cancer scars the shit out of me.

You know it's not like the connection between anal cancer and HIV is a new thing.  I remember the New York City health department showing that tv commercial about HIV a few years ago that showed anal cancer in it.  These HIV clinics that don't screen are very discouraging. 

"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline edfu

  • Member
  • Posts: 1,084
Re: Have you had your HRA yet this year?
« Reply #24 on: September 30, 2013, 12:58:42 AM »
I never had and signs or symptoms that something was wrong. 

Indeed, neither did I.  That's one of the confounding things that contributes to this medical scandal, where the science is known and recognized by the experts but so many doctors have refused to acknowledge it and to take steps to take care of it.  Much of this I attribute--instinctively but without concrete proof--to the last vestiges of a once horrific medical homophobia.   
« Last Edit: September 30, 2013, 01:16:36 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 aaware72

  • Member
  • Posts: 199
Re: Have you had your HRA yet this year?
« Reply #25 on: September 30, 2013, 02:52:52 AM »

My last Pap was done by a doctor who moved his practice out of the area, and my last HRA, three years ago, was done by a doctor who has since retired and insisted that I had to be admitted to a hospital for him to do it.
Since then, I haven't been able to find a single doctor in the whole state of Connecticut who performs HRA's--not even in the Yale-New Haven medical complex.  I don't need another Pap; the last one showed I needed to be examined further with an HRA, and my last HRA confirmed that I do indeed need to be carefully watched.  The only alternative is to have it done in NYC, but my insurance won't cover it out of state. 

I know from research that this problem is not unique.   


I'm not sure if you want to travel?  Dr Davis runs a HRA clinic on Wednesday and Fridays in the ID department in the Cox building at Mass General in Boston.

I know they are willing to bill out at the medicaid rate.  I don't understand why the insurance would not cover this being done in another state?
« Last Edit: September 30, 2013, 02:55:45 AM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline edfu

  • Member
  • Posts: 1,084
Re: Have you had your HRA yet this year?
« Reply #26 on: September 30, 2013, 11:28:06 PM »
I don't understand why the insurance would not cover this being done in another state?

Thanks for the info, but many insurance plans will only cover services performed in the same state as your  residence, particularly if they employ doctors only within their network, which is geographically limited to the one state.       
"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 tednlou2

  • Member
  • Posts: 4,613
Re: Have you had your HRA yet this year?
« Reply #27 on: October 07, 2013, 04:26:10 PM »
This thread reminded me that it was probably time to have a booty follow-up.  So, I made an appt and was also going to ask again about HRA's and paps.

Well, this appointment is coming at a good time.  I was examining myself in the shower today, as I regularly do.  I stick my finger in a bit, to see if I feel anything amiss, as well as checking the outside.  I felt a hard lump just inside.  I would say it is the size of a marble.  It stings a little when touching it, so I'm hoping just a hemorrhoid.  I've read they can cause a bump like that.  When you feel a lump like that, it is worrisome.  I regularly examine myself (insert jokes here), so I am sure I would have felt it, if it had been there before. 

Does this sound like a hemorrhoid thing? 

Edited for spelling

Offline Jeff G

  • Global Moderator
  • Member
  • Posts: 9,368
  • How am I doing Beren ?
Re: Have you had your HRA yet this year?
« Reply #28 on: October 07, 2013, 04:46:54 PM »
This thread reminded me that it was probably time to have a booty follow-up.  So, I made an appt and was also going to ask again about HRA's and paps.

Well, this appointment is coming at a good time.  I was examining myself in the shower today, as I regularly do.  I stick my finger in a bit, to see if I feel anything amiss, as well as checking the outside.  I felt a hard lump just inside.  I would say it is the size of a marble.  It stings a little when touching it, so I'm hoping just a hemorrhoid.  I've read they can cause a bump like that.  When you feel a lump like that, it is worrisome.  I regularly examine myself (insert jokes here), so I am sure I would have felt it, if it had been there before. 

Does this sound like a hemorrhoid thing? 

Edited for spelling

I like those tiger eye marbles . Sounds like a rhoid to me .

I brought up HRA at the last patient advisory board meeting and was told they always send people with a history of displaysia ( spelling ? ) for a HRA , that was news to me because I have a history and abnormal paps and have never been followed up with on the matter . I will be insisting on a HRA my next visit ... I hope all they find is some cool marbles like Teddy has . 

Offline marcmoral16

  • Member
  • Posts: 86
  • Me and my Partner
Re: Have you had your HRA yet this year?
« Reply #29 on: October 07, 2013, 04:48:39 PM »
I'm in a clinic in NYC that my PCP does the PAP annually in my chart. It hurt so bad she plunged her finger in then the swab.

On the other end my partner was saved by this and I swear by it now. He had his done and and came back needing to be reviewed. Went for the HRA at a local hospital and came back with abnormalities, since been diagnosed with stage zero cancer. Caught early enough he is sure to be fine.

So I would have everyone checked and hopefully get and HRA done if available to you.
Tested Positive Jan 16 2013
CD4 119 6% VL 23980
Started Complera Feb 2013
March CD4 199 9% VL 1000
May CD4 255 12% VL 334
June CD4 284 15% VL 172
Switched to Stribild middle June 2013
July CD4 325 22% VL 51
October CD4 341 23% VL UD!!
Jan 2014 CD4 343 20% VL <20

Offline tednlou2

  • Member
  • Posts: 4,613
Re: Have you had your HRA yet this year?
« Reply #30 on: October 07, 2013, 05:04:48 PM »
I like those tiger eye marbles . Sounds like a rhoid to me .

I brought up HRA at the last patient advisory board meeting and was told they always send people with a history of displaysia ( spelling ? ) for a HRA , that was news to me because I have a history and abnormal paps and have never been followed up with on the matter . I will be insisting on a HRA my next visit ... I hope all they find is some cool marbles like Teddy has .

Some pearls just fell out!  I'm like an oyster.   ;)

Offline cicero

  • Member
  • Posts: 66
Re: Have you had your HRA yet this year?
« Reply #31 on: October 09, 2013, 10:43:16 PM »
Not so ... many city's large and small are slow to offer this beneficial test .

Yes, unfortunately finding a doctor able to do this is difficult outside of New York City.  Anal paps are easier to come by, as someone else said, they're very easy, basically not that different from a vaginal pap.  I was in a clinical trial study for several years in NYC about anal intrapitheal neoplasia, which is where I even learned about the need for paps and HRAs.  This was before I was HIV+ and I was worried about the follow up I would be able to find in NC without travelling back to the city...still a concern for those of us who have had abnormal cells.

At any rate, that is very good news that about your results, I know I dreaded hearing "high grade". 
"How could this happen to lovely me?" -Jacqueline Susann

Offline RobbyR

  • Member
  • Posts: 244
Re: Have you had your HRA yet this year?
« Reply #32 on: November 01, 2013, 05:21:14 PM »
I had a pap last December of 2012 and glad I did. They found low grade lesions, but all the docs told me basically I just need to be proactive & get another pap in 6 months or a year. The colorectal doc I see who sees a lot of HIV positive patients for various issues told me that I don't really need to have a high-resolution anoscopy unless & until a pap shows a higher grade lesions (if that happens). But he said it was up to me.

I'll be having another pap in a month or two, & then if the results are better or the same, I may postpone the HRA for now. If a pap shows a higher grade result though, I'll definately have the high res anoscopy. I've had colonoscopies and luckily no malignancies were found, so that's reassuring. The name of the game is making SURE you have paps fairly often! And a high res anoscopy if need be.
Started Atripla August, 2010.

vl in December, 2013: Undetectable

cd4 in December, 2013: 650

Diagnosed Bipolar I in 2013.

Offline aaware72

  • Member
  • Posts: 199
Re: Have you had your HRA yet this year?
« Reply #33 on: November 02, 2013, 07:21:32 PM »
I had a pap last December of 2012 and glad I did. They found low grade lesions, but all the docs told me basically I just need to be proactive & get another pap in 6 months or a year. The colorectal doc I see who sees a lot of HIV positive patients for various issues told me that I don't really need to have a high-resolution anoscopy unless & until a pap shows a higher grade lesions (if that happens). But he said it was up to me.

I'll be having another pap in a month or two, & then if the results are better or the same, I may postpone the HRA for now. If a pap shows a higher grade result though, I'll definately have the high res anoscopy. I've had colonoscopies and luckily no malignancies were found, so that's reassuring. The name of the game is making SURE you have paps fairly often! And a high res anoscopy if need be.

My understanding was all that a pap does is determined if there were abnormal cells and that an HRA was required to obtain more information about these abnormal cells.  Only when you have an HRA done can they see is you have a lesions and take a biopsy to test to see what type of lesions you may have. 



"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline phildinftlaudy

  • Member
  • Posts: 2,950
  • sweet Ann what you think babe...
Re: Have you had your HRA yet this year?
« Reply #34 on: November 02, 2013, 07:26:46 PM »
I asked my ID doc about anal pap and HRA at my last visit... She agreed it should be done - and wanted to schedule the HRA first; however, that was going to involve jumping through some hoops with insurance, etc., so we are doing the anal pap in April (my next visit).... She said about 60%-70% of time abnormalities are detected, which will than require an HRA - so, given my history of medical abnormalities  ;D   I expect that an HRA will occur in April or May 2014.... 
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline RobbyR

  • Member
  • Posts: 244
Re: Have you had your HRA yet this year?
« Reply #35 on: November 02, 2013, 09:41:47 PM »
My understanding was all that a pap does is determined if there were abnormal cells and that an HRA was required to obtain more information about these abnormal cells.  Only when you have an HRA done can they see is you have a lesions and take a biopsy to test to see what type of lesions you may have.

You may be right, I'm just going by what my doctors have said. I asked my colorectal doc about it in July, they have all told me a low grade result is no major cause for concern, & even a higher grade lesion is totally treatable. I'll be having another pap this month or next, so a year since my last. They told me my pap showed low grade intre(something) lesion, which is abnormal, but again they reassured me that this is no cause for immediate concern just need to have regular paps. My colorectal doc said there wasn't a need for an immediate HRA based on one low-grade pap result. But they said I could get an HRA if I want. I do plan on getting one soon. I may try & schedule it when I see my colorectal doc for my follow up in a week's time, maybe have it end of this year or beginning of next. Docs all told me one low-grade pap result basically doesn't require anything but monitering. Name of the game is regular paps. HRA if desired.

I've been trying to take great care of myself, haven't been anally sexually active, watching diet, not smoking, etc. So hopefully the result will stay the same or even improve on my next test.
Started Atripla August, 2010.

vl in December, 2013: Undetectable

cd4 in December, 2013: 650

Diagnosed Bipolar I in 2013.

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #36 on: November 02, 2013, 10:15:54 PM »
A study was published today titled "Abnormal anal cytology found in half of all hiv positive gay men." 

Reading the study requires a subscription so I will just copy and paste the article here. 

It's a bit long and dry...so sorry about the long post

BRUSSELSó Anal dysplasia is frequent in HIV-positive men who have sex with men. Longer sustained control of HIV is associated with less high-grade anal intraepithelial neoplasia, according to a recent study.

"Among patients with abnormal cytology, 83% had abnormal biopsy, including half with high-grade anal intraepithelial neoplasia," said AgnŤs Libois, MD, from the infectious disease service at the Saint-Pierre University Hospital in Brussels.

She explained that anal cancer is caused by infection with high-risk types of the human papillomavirus (HPV) and is preceded by high-grade dysplasia. Anal cancer occurs at a younger age in people who are HIV-positive than in those who are not (about 40 vs 60 years). In HIV-positive men, the prevalence of anal HPV might be as high as 95%, whereas in heterosexual men, it is 60%.

Dr. Libois presented the study results here at the 14th European AIDS Conference.

The prospective study evaluated 425 HIV-positive men who have sex with men who underwent anal cytology screening. If the results were abnormal, patients were referred for high-resolution anoscopy and biopsy. Biopsy histologies were classified as normal or as anal neoplasia grades 1, 2, or 3, with 3 being a cancer precursor.

The screened population was 90% white, mean age was 44.5 years (range, 22 - 71 years), 85% were on antiretroviral therapy, 73% had a viral load below 50 copies/mL, and median CD4 count was 632 cells/μL. The median duration of HIV was 7.5 years, and the median time on antiretroviral drugs was 7.0 years.

Of the 382 smears of sufficient quality for analysis, 48% were abnormal, according to the modified Bethesda System ó 19% were atypical squamous cells of undetermined significance, 4% were atypical squamous cells where a high-grade lesion could not be ruled out, 22% were low-grade squamous intraepithelial lesions, and 3% were high-grade squamous intraepithelial lesions.

Patients with normal cytology were more likely to have undetectable viral loads than those with abnormal cytology (82% vs 62%; P < .001), and were taking combination antiretroviral therapy for a longer period of time (111 vs 49 months; P = .002). There was no correlation between cytology and age or current or nadir CD4 count.

Of the 118 high-resolution anoscopy with biopsies performed on the 183 patients with abnormal cytology, 17% of the biopsies were normal, 33% were neoplasia 1, and 39% were neoplasia 2/3. Interestingly, the high-grade specimens fell into all 4 Bethesda System abnormal cytology categories. Neoplasia 2/3 did not correlate with age, current CD4 count, or HIV viral load.

Table. Risk Factors for High-Grade Anal Neoplasia on Multivariate Analysis

Risk Factor   Odds Ratio   95% Confidence Interval    P Value
Nadir CD4 <100/μL   2.80   1.20Ė6.30   .014
Shorter duration with median HIV viral load <50/mL   0.96   0.94Ė0.98   .040
Age   0.97   0.94Ė1.00   .160
Dr. Libois concluded that anal dysplasia and high-grade neoplasia are frequent in HIV-positive men who have sex with men, and cytology with or without biopsy is the only way to detect lesions. Normal cytology "was associated with an undetectable viral load and a longer duration of combination antiretroviral therapy," whereas the risk for neoplasia 2/3 was increased with a nadir CD4 count below 100 cells/μL and a shorter time with an undetectable viral load.

"Longer sustained HIV control was associated with less anal neoplasia 2/3," Dr. Libois said, but it is an open question whether early initiation of antiretroviral therapy decreases the incidence and prevalence of anal cancer in this population.

She noted that most studies have shown that combination antiretroviral therapy has no effect on anal dysplasia, but the duration of therapy was often 2 years or less. Some recent studies with a longer duration of therapy have shown a beneficial effect, and one showed that a longer time with an undetectable viral load and a higher nadir CD4 count were associated with a lower incidence of anal squamous cell cancer.

These researchers "are essentially reporting the exact same prevalence and the high level of HPV anal intraepithelial neoplasia" as seen in the Chelsea and Westminster cohort study from London (Curr Opin HIV AIDS. 2009;4:64-67), said session chair Fiona Mulcahy, MD, from St. James's Hospital of Trinity College in Dublin, Ireland.

"You could spend your whole life in a clinic doing anoscopy and doing high-resolution anoscopy and biopsy, but actually there are no clear patterns of management for advanced disease. Our problem is that with anal intraepithelial neoplasia, there's no specific intervention that seems to be curative because of the recurrence rates," she told Medscape Medical News.

She said that many studies, but not all, have shown that CD4 cell nadir seems to have an impact. In addition, as Dr. Libois's team showed, the longer patients are on treatment, the less likely they are to have high-grade lesions. However, there are conflicting results on this point. Anal neoplasia "seems to be advancing irrespective of our control, which is also a bit of a worry," Dr. Mulcahy said.

As the data stand, she said, they do not push her to start treating everyone early with antiretroviral therapy.

There was no commercial funding for the study. Dr. Libois reports no relevant financial relationships. Dr. Mulcahy reports work with AbbVie, BMS, Merck, and GSK, and Gilead.

European AIDS Clinical Society: 14th European AIDS Conference: Abstract PS6/3. Presented October 17, 2013.
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline aaware72

  • Member
  • Posts: 199
Re: Have you had your HRA yet this year?
« Reply #37 on: November 03, 2013, 12:42:23 PM »
You may be right, I'm just going by what my doctors have said. I asked my colorectal doc about it in July, they have all told me a low grade result is no major cause for concern, & even a higher grade lesion is totally treatable. I'll be having another pap this month or next, so a year since my last. They told me my pap showed low grade intre(something) lesion, which is abnormal, but again they reassured me that this is no cause for immediate concern just need to have regular paps. My colorectal doc said there wasn't a need for an immediate HRA based on one low-grade pap result. But they said I could get an HRA if I want. I do plan on getting one soon. I may try & schedule it when I see my colorectal doc for my follow up in a week's time, maybe have it end of this year or beginning of next. Docs all told me one low-grade pap result basically doesn't require anything but monitering. Name of the game is regular paps. HRA if desired.

I've been trying to take great care of myself, haven't been anally sexually active, watching diet, not smoking, etc. So hopefully the result will stay the same or even improve on my next test.

The reason my ID(who happens to also performs HRA) said it was important to have an HRA is because there is a greater risk for those that have HIV.  Which is what buginme post about.  If I were you and am I not I would question this colorectal doc as they may not be fully informed about people with HIV.

My Doctor is:
Benjamin T. Davis, MD
Director, Combined MGH/BWH/DFCI Fellowship Program

http://www2.massgeneral.org/id/
« Last Edit: November 03, 2013, 12:46:50 PM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline boomer

  • Member
  • Posts: 42
Re: Have you had your HRA yet this year?
« Reply #38 on: November 10, 2013, 09:25:44 AM »
I have done a good deal of research on this subject and have found these two sources of information to be very helpful: http://id.medicine.ucsf.edu/analcancerinfo/ and http://www.analcancerfoundation.org/resources/medical-resources/.

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #39 on: March 05, 2014, 03:19:20 PM »
OMG I am tired of having to deal with this.  Had another HRA, pap, biopsy on monday and again my results are ALWAYS the SAME:

"Anal Canal Pap: Final Cytology Diagnosis
EPITHELIAL CELL ABNORMALITY: Atypical squamous cells; cannot exclude high grade squamous intraepithelial lesion."

Another HRA/PAP/Biopsy in 4 months.  I've had so many in the past few years I've lost count and am getting a bit tired and worried.

This is bullshit :-)
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Offline pittman

  • Member
  • Posts: 141
Re: Have you had your HRA yet this year?
« Reply #40 on: March 05, 2014, 09:18:41 PM »
I just had mine done with biopsy as well. I really hate going in for these, though I fully understand the importance.  They always seem to end up doing a biopsy, but other than the first two times, they always end up low grade at least.

On an interesting side note, I had to start going to another office (same doctor) based on my insurance provider. Turns out they no longer take mine or several others. As a result, they have us go to a different office and simply do it all for free!  Totally impressed with that commitment to the health of their patients in that they insist on not even making us pay an out of network charge.

Online Miss Philicia

  • Member
  • Posts: 23,577
  • celebrity poster, faker & poser
Re: Have you had your HRA yet this year?
« Reply #41 on: March 06, 2014, 08:41:20 AM »
Bugsy, I don't understand the need to do PAPs when they are doing routine HRAs -- it seems unnecessary. What is the purpose? Nor do I understand why they are monitoring you so frequently. It all just seems outside of my experience and I have been going for this stuff now for over a decade, under the care of two different doctors in that span.

That reminds me though that I need to call the new doctor I'm switching to (for better location convenience) and snag an appointment as my last HRA was in April or May.

In the scope of all the other crap I go to specialists for I don't really mind these appointments. These days it's the only time anything gets inserted into my rectum.
"Iíve slept with enough men to know that Iím not gay"

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #42 on: March 06, 2014, 01:24:21 PM »
Bugsy, I don't understand the need to do PAPs when they are doing routine HRAs -- it seems unnecessary. What is the purpose? Nor do I understand why they are monitoring you so frequently.

The clinic always has done HRA's and PAP's together.  At least as long as I have been there.  The clinic is a research site for the Aids Malignancy Consortium and they are running a couple hpv studies so I wonder if that has something to do with their "process."   There is usually some med student watching and a couple of times there have been doctors from other parts of the country that are learning how to do HRA's in there watching.  There is nothing like having an audience watching your doctor look in your ass.

As far as being done so frequently.  Well, reading between the lines I get the impression that I have run out of treatment options.  They can only do Infrared Coagulation so much and I have been through the topical options and vaccine.  So now its close monitoring. 

Normally they only see people once per year..twice per year if you have issues.  I get to go every 4 months because Im special.
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

Online zach

  • Member
  • Posts: 790
Re: Have you had your HRA yet this year?
« Reply #43 on: March 06, 2014, 01:40:40 PM »
omg, why did i read this thread while eating scrambled eggs? more, why did i do a google image search?

why couldn't it have just been a health reimbursement account?!?!?!?

my eyes, it burns
pour the coldest beer
raise another glass to the friends so near
high, on your dreams so clear
cheers

Offline Jeff G

  • Global Moderator
  • Member
  • Posts: 9,368
  • How am I doing Beren ?
Re: Have you had your HRA yet this year?
« Reply #44 on: March 06, 2014, 01:44:31 PM »
omg, why did i read this thread while eating scrambled eggs? more, why did i do a google image search?

why couldn't it have just been a health reimbursement account?!?!?!?

my eyes, it burns

Do you put ketchup on the eggs . Sorry for the hijack bugs but I could not resist . 

Online zach

  • Member
  • Posts: 790
Re: Have you had your HRA yet this year?
« Reply #45 on: March 06, 2014, 01:48:17 PM »
i do actually, pretty much every morning of my adult life. two scrambled eggs, mixed with one chopped up fried potato, ground sausage, mushrooms, cheddar cheese, ketchup on the side

perhaps these posts should be moved to the wumpette nutritional thread
pour the coldest beer
raise another glass to the friends so near
high, on your dreams so clear
cheers

Offline buginme2

  • Member
  • Posts: 2,757
  • Certified Life Coach
Re: Have you had your HRA yet this year?
« Reply #46 on: March 06, 2014, 02:04:23 PM »
. snapshot
Sorry for the hijack bugs but I could not resist .

That's ok. Actually they are not kidding when they call it "high resolution" anoscopy.  Your rose bud gets put up on the big screen in HD.  It's hard not to look, kind of like a bad accident.
"All I need are some tasty waves, a cool buzz, and I'm fine."

http://www.youtube.com/watch?v=6e0gcEC1TWE

 


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.