Author Topic: High Rez Anoscopy (Read 6335 times)

buginme2 · « **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.

Miss Philicia · « **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.

buginme2 · « **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.

Miss Philicia · « **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.

Tim Horn · « **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

buginme2 · « **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.

Jeff G · « **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 ?

emeraldize · « **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

Miss Philicia · « **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.

emeraldize · « **Reply #9 on:** July 14, 2011, 04:48:22 pm »

Quote from: Miss Philicia 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.

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 “abnormal,” 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.

buginme2 · « **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!

emeraldize · « **Reply #11 on:** July 14, 2011, 08:34:28 pm »

You're most welcome.

edfu · « **Reply #12 on:** July 15, 2011, 05:05:59 am »

Quote from: jg1962 on July 14, 2011, 03:29:06 pm

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.

bocker3 · « **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

buginme2 · « **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.

buginme2 · « **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

Forums Index

Welcome

Author Topic: High Rez Anoscopy (Read 6335 times)