HPV...Scared :(

[Hopeful2016]

Hello dear members of the forums..
It's me again, it seems that getting rid of some health problem must be accompanied by getting another one.

I went to the dermatologist because of continuous tinea versicolor infection despite my high personal hygiene, he prescribed an antifungal cream then he checked me.

SURPRISINGLY, despite being sexually inactive (i didn't touch anyone since my hiv diagnosis) he said that i have genital warts on my anus and must be inside also. I got a shock because I didn't notice or felt them.
He prescribed Aldara cream and adviced me to take gardasil vaccine and that's it.
I went to another doctor to seek a second opinion, he checked me and inserted a proctoscope inside my anus and said
"You have flat warts outside and one wart just near opening of your anus and no warts inside but you need to freeze them by cryotherapy then we will use aldara cream for prophylaxis and you must do STDs panel tests including hiv test(i didn't disclose to him that I'm hiv positive)
he said if you are positive for hiv then we will also inject interferon inside your sphincter of your anus because hivers are immunocompromised and recurrence rates are high among them compared to hiv negatives

I asked him about follow up with pap smears and HRA to scan for anal dysplasia which is the precancerous form of anal cancer, he said we don't do pap smears for men neither HRA all i can do is proctoscopy and anal dysplasia is very rare and you don't need to take gardasil vaccine!!!

1-Do HPV associated with anal cancer really in hiv positive patients? If so how common?
2- does HPV flat warts(i don't have the cauliflower shape)  have a high recurrence rate in hivers as he said?
3-does proctoscope is enough to detect any lesion before it becomes a cancer and does it eventually becomes a cancer?

Which one of the two doctors i follw his plan?
If anyone has any experience... Please tell me I'm in a total loss... THIS hpv scares the hell out of me

[harleymc]

The quick answer is that anal cancer is much more frequent among people living with HIV than not. That being said it's also uncommon for PLWHA.

As your cd4 count rises, your risk will drop.

[Jim Allen]

Can't add from personal experience to your thread as I have none on this topic. However the poz lesson on this does address the questions you have asked, so thought I would add that for you.

https://www.poz.com/basics/hiv-basics/human-papilloma-virus-hpv

[CanadianExpat1983]

This issue has been making me lose sleep too. HIV + MSM engaging in receptive anal sex is the highest risk group. Anal Pap smear, HRA, HPV DNA PCR (latter may give false neg result if latent) has been deemed crucial to detect anal cancer bio-markers (i.e. AIN, HGIL) per publications/ studies in this field but some of these aren't recommended for men by doctors. Therefore, you will have hard time persuading doctors to perform these on you.

Almost half of the anal cytology results are false negative. Co testing( anal pap smear and HRA) should be standard for this risk group.

PROCTOSCOPE detects hemorrhoids, anal fissures, fistula and perhaps cancerous growths. You need your anus examined 20 to 40 times magnified via HRA. This procedure requires advanced skills and training.

Print out studies on this issue and bang them on your doc's office desk!

Also, go    head with your HPV shots.

Early detection of HGIL is key for favourable prognosis.

[Hopeful2016]

Can't add from personal experience to your thread as I have none on this topic. However the poz lesson on this does address the questions you have asked, so thought I would add that for you.

https://www.poz.com/basics/hiv-basics/human-papilloma-virus-hpv

Thank you ☺

[Hopeful2016]

up. Anal Pap smear, HRA, HPV DNA PCR (latter may give false neg result if latent) has been deemed crucial to detect anal cancer bio-markers (i.e. AIN, HGIL) per publications/ studies in this field but some of these aren't recommended for men by doctors. Therefore, you will have hard time persuading doctors to perform these on you.

Almost half of the anal cytology results are false negative. Co testing( anal pap smear and HRA) should be standard for this risk group.

PROCTOSCOPE detects hemorrhoids, anal fissures, fistula and perhaps cancerous growths. You need your anus examined 20 to 40 times magnified via HRA. This procedure requires advanced skills and training.

Print out studies on this issue and bang them on your doc's office desk!

Also, go    head with your HPV shots.

Early detection of HGIL is key for favourable prognosis.

NO DR here is performing anal pap smear let alone that they don't even know about HRA... I went to two colorecal surgeons...they don't know anything about HRA.
All they did is digital rectal examination and proctoscopes.
I don't know what can I do?

[bocker3]

It is frustrating that anal pap smears seem to be so rarely done and that folks have doctors who say they don't do them.  Given that it is not much different than a cervical pap smear (except for where one inserts the swab).  Once a sample is obtained, the test is pretty much EXACTLY the same as a cervical pap smear.  I mean, really, if cervical pap smears are routinely performed, then anal pap smears can be done.  It seems to be a case of "never done it, so don't want to".

Here is a link one can share with their doctor on how to obtain a sample (it really is a simple procedure):

http://analcancerinfo.ucsf.edu/obtaining-specimen-anal-cytology

It is not all that surprising that HRA's aren't readily available - at least outside of major metro areas.  However, if the anal pap was done more routinely, it could then be followed up with an HRA, if warranted -- even if it did require some travel.

Mike

[harleymc]

I had my annual HRA ( High Resolution Anoscopy) yesterday.

One of my high grade lesions had completely resolved, the other was small circa 2 mm and was biopsied.

The evidence base is rapidly confirming that observe and monitor is the safest approach.

[Hopeful2016]

I had my annual HRA ( High Resolution Anoscopy) yesterday.

One of my high grade lesions had completely resolved, the other was small circa 2 mm and was biopsied.

The evidence base is rapidly confirming that observe and monitor is the safest approach.

Thank you very much for your follow up... Keep us posted about updates of SPANC study and your case, wishing all the best for you

[harleymc]

Got my biopsy results back it was a HSIL. I'm yet to have an appointment with the study doctor to discuss.

I did go to an information night, for the SPANC study which is nearly over. There was a strong recommendation from the doctors that we do annual self examination with a finger, apparently anomalies as small as 3mm can be detected by untrained people. I'll just have to sure to wash my hands obsessively afterwards. ;-)

[Hopeful2016]

Got my biopsy results back it was a HSIL. I'm yet to have an appointment with the study doctor to discuss.

I did go to an information night, for the SPANC study which is nearly over. There was a strong recommendation from the doctors that we do annual self examination with a finger, apparently anomalies as small as 3mm can be detected by untrained people. I'll just have to sure to wash my hands obsessively afterwards. ;-)

So what does the doctor say about your second HSIL which didn't resolve by its own?
Does he recommend treatment or still watching and waiting?
I need also to understand from you when will treatment be be a necessary action??
treatment an

[Wade]

Hi, I have had HRA procedures for the past several years and as the others explained it is diagnosed with a simple pap smear. I'm really sorry I thought I responded in your thread but it was in another on the same topic. I will post it here.

https://forums.poz.com/index.php?topic=67543.0

Best,

Wade

[doctor_sexologist]

HI everybody.
First of all we need to do HPV Screening and find out which type of HPV you have high risk or low risk, or maybe both. Mostly genital warts are connected with HPV 6/11 which is low risk and can bring cosmetic problems.
In My country/Armenia Aldara (imiquimod) is not available, but Aldara also very effective for warts.
I advise to my patient to do Cryotherapy or surgical removall.
If you have no high risk HPV, you need to get Vaccine(for example Gardasil), because you can get HPV even If you do protected sex.
High risk HPV can lead anal, oropharyngeal cancer. HIV positive people has a serious problems if they have very low CD4 counts, if you are doing great with your meds and has a good CD4 you just need to give PAP smear and doctor will advise you what to do next. High risk HPV lead to cancer mostly in 15 years, it is not so quickly and you can control the process.
Have a nice day

[Wade]

Hi,

While your knowledge and insight is appreciated, you must be living with HIV to be a member and post in these forums.
Please introduce yourself before you post anything further.

Best,

Wade