hiv and hpv your thoughts on getting an early start with meds

[livingpos]

hi all,

my doc and I are discussing the possibility of starting meds early. I have been pos for 1.5 years. From sero conversion CD4 450 and VL in the millions the numbers bounced around a bit in the next few tests. CD4 650 VL 1800, CD4 550 VL 17000, CD4 450 VL 65000, CD4 700 VL 16000. Percentage has hovered around 32-35. It seems that things have settled down since the last numbers were looking good. I'll have the next test in 2 weeks.

The problem is the HPV. It went apeshit! There were so many warts in the perianal area that I had to have them removed under general anaesthetic. Twice! And they are back again worse than before. Doc thinks that my body might be doing ok with the hiv infection but is struggling to manage the hpv on top of it. He thinks that if meds can take care of the hiv my body might be able to spare some energy to devote to the hpv. No garantees but sounds logical.

I also have the herpes simplex that causes cold sores on the mouth. I haven;t had one since being pos but I started getting one yesterday.

I have nothing against early treatment per se. I have read all the benefits. But I also would like to stay off the meds as long as possible for all the usual reasons. It seems a pity to start with a CD4 of 700 and a percentage in the normal range. BUT i really can't take these anal wart outbursts anymore! I will have the anal pap smear and have them removed again in 2 weeks.

Any thoughts on early starts with multiple infections? I trust my doc implicitly. He has been working with hiv for 20 years but I also value the lessons of experience.

thanks
Jonathan

[aztecan]

Wow Jonathan,

This is a toughy. I really don't know a lot about HPV. Are there any other options to eradicate this problem aside from starting ARV therapy?

I am an advocate of starting ARV therapy earlier rather than later, but this is much earlier.

But, if the only option is removal, as you have had in the past, what your doctor said regarding your body's ability to fight off the HPV ourbreaks makes sense.

I have known others who suffered similar outbreaks and who improved after beginning ARV therapy. But, all of those whom I have known had much lower CD4s and higher viral loads.

You said you would like to postpone starting meds at this point. I don't blame you there. Your counts are good.

Starting now might help the HPV problem or might not, as your doc said.

If it were me, I think I would start meds simply because of the pain and anguish you are suffering because of the HPV.

Years ago, my doc gave me a somewhat similar option. My CD4s were still in the 400s and viral load of about 50,000.

She said she had no idea what the long-term side effects would be or how long I would be able to tolerate the meds.

I lasted 11 years on that regimen, which is pretty good.

Today, there are many new meds and the side effects are better known on many of them.

If I were given the chance to end the HPV problem with my backside, as you have been, I think I would give it some hard, serious thought, but would probably opt to try it.

I would rather take a chance, even without a certain outcome, rather than do nothing and let things continue as they are now.

Just my 2¢ worth. Let me know what you decide.

HUGS,

Mark

[Miss Philicia]

Well, I for one had feisty, feisty anal warts and I was on HIV treatment, and had been so for five years by then.  My numbers were probably up in the mid-400 cd4's at the time.  Not sure what my VL was as that test wasn't available in that year.  Minor were also eventually surgically removed after many unsuccessful attempt by less invasive methods.  Thankfully they never returned for me after the surgery.  Sorry to hear about your current situation, as I *totally* know what it's like.  That was a wretched year for me.

Anyway, exactly how high does he state your numbers need to be for your body to deal with getting rid of the AW's?  I'd be less skeptical of his claims if you numbers were really low, but they aren't.  It's just I've never heard of this before, so I'll be interested if anyone else has.  To be honest it's rather typical of them to return, and the CDC recommends checkups every 3-6 months for 1.5 years for this very reason, and this is exclusive of HIV status.

I assume you're having your PCP taking care of this right now?  Maybe you'd feel better seeing a butt doctor specialist (forget what they're called), preferably one that treats a sizable amount of gay people and thus will be quite familiar with the HIV angle.

[J.R.E.]

Wow Jonathan,

This is a toughy. I really don't know a lot about HPV. Are there any other options to eradicate this problem aside from starting ARV therapy?

I must have had the HPV for some time, prior to starting on meds, but it was not visible. For me, the problem started shortly after the  antiretrovirals were started. I wonder if that was immune reconstitution syndrome??

Aldara Cream didn't do anything, The podofilox solution made them all go away, except every once in a while, I have to reapply it, so I have an endless refill for the podofilox solution, for the time being.



Ray

[J.R.E.]

Also just a reminder, you don't have to be HIV positive to get HPV. It's highly contagious, through contact !


Ray

[livingpos]

Mark, philly and Ray

thank you for your replies, much appreciated. You're right you don't have to pos to have hpv and warts, but what a daily reminder it has been, as if the hiv wasn;t enough to deal with. And as for them being contagious i have had to kiss any sexual contact goodbye!

Doc isn;t making any promises, he's much to honest for that. Its just a guess at a strategy that might work but no research or evidence to support it. He went back and did extensive research on who's trying what therapies but it seems its quite limited. Aldara produces results while i am using it but as soon as i stop its back to square one. I will discuss the podofilox with the doc.

Philly, Ray your experience of warts even on hiv meds is helpful to me, thanks. If my test results are still as good, I think I will forego starting meds and opt for the surgery and one more try. Doc will send me to a surgical proctologist that is experienced with this. Lets see what he says. If I'm gonna go through the pain again, he better stay down there till he gets em all! 

Mark ur 2cents is worth its weight in gold, your replies always have such optimistic candor.

all the best to you and thanks
Jonathan

[whizzer]

Jonathon,

There IS a documented relationship between HIV viral load and HPV.  It has been noted that VL>10,000 results in an increase in HPV and abnormal pap smears.  It is thought that HIV somehow effects HPV expression, either directly  by HIV itself or by local cytokine production.   

Some clinicians have noted a significant difference in viral load (but interestingly, NOT CD4) between HIV positive patients with warts who experienced a relapse in HPV infection, and those who did not relapse.  It is surmised that HAART would have an indirect benefit on HPV lesions.

Here's a Medscape article.  You have to join to read it, but it is free:

http://www.medscape.com/viewarticle/410246_3

Good luck with your treatment.  I hope you get a favorable outcome.

-Whiz

[J.R.E.]

Here's a Medscape article.  You have to join to read it, but it is free:

http://www.medscape.com/viewarticle/410246_3

Good luck with your treatment.  I hope you get a favorable outcome.

-Whiz

Whiz,

Thanks for that article. Very informative. I thought I had read most articles, but I missed this one.



Thanks---Ray

[Miss Philicia]

That's very interesting whizzer.  Thanks.

[livingpos]

whizzer... thanks... and to all others yet again prood of the benefits of shared wisdom and resources... love to all
Jonathan