Hello, I am a person living with HIV for over 17 years now and still not on meds because of how slow HIV is progressing with me. However, It's getting close to time for me to start. For the past 6 years my t-cells have ranged stayed between 290-360, 20-22%, and my viral load has always been lower than 2000. Approximently 4 years ago I developed several medium sized external and internal rectal warts and I'm really worried about rectal cancer. My doc has given me two or three different treatments all with have failed to clear them up. My questions are as followed: How do I know if the kind of HPV that I have is cancerous? Do you think when I start meds they will clear up? Any reccomendations on what I should do?

I REALLY appreciate your help. Thanks! Chicago

Hi Chicago HPV types that cause lumpy warts are often not the cancerous type although diferent HPV types often travel together. An anal pap smear or biopsy of the warts may enable them to be typed in a specialist laboratory. However, different types can be in different patches around the same area. Anal cancer in persons with HIV is more comon in persons with more HPV sub-types and in persons with lower CD4 nadirs and smokers. So probably a good time to start medications. Your doctor may be able to offer anal pap every year to monitor cancer risk. Surgical treatments and imiquimod therapy are worth doing if these have not been tried. The warts may resolve with improved immune function on therapy. I hope this helps Best of Luck Dr Moyle