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Doc Says I Have HPV, Prognosis?
Mar 18, 2013

Dr. Vergel,I got the results of my anal pap test and it said I have Low Grade Sqauamous Intraepitheal Lesion (LSIL). Said Transformation Zone Elements Glandular & Metaplastic Cells Identified. ACS-US & LSIL have significant risk for having HSIL. Recommends I have hi-res anoscopy with biopsy as indicated.

So in layman's terms, what is my prognosis Dr. Vergel? The doctor told me I have the lowest grade of abnormality for an anal pap, and that most cases go away on their own or don't get worse. She said many men have this and don't even know it, so it is good that I am being so proactive.

I plan on having the hi-res anoscopy soon. The doc assured me I do not have cancer, and can continue living my life as normal. Just wondering if this is something that is manageable and will it turn into cancer. HIV is stressful enough without this.

Also, I am not having any type of anal sex now, and have not for several years. I am quite healthy overall and my cd4 and viral load numbers are good. Just wanting some input. Thanks Dr. Vergel!

Response from Mr. Vergel

First of all, I am not a doctor. I am an educated patient, treatment educator and activist. I have gathered a lot of information and experience through my 30 years of HIV infection, but my replies only include suggestions and references to studies, not medical advise.

If your pap smear came up positive, go ahead and get an high resolution anoscopy (HRA) since pap smears are not 100% accurate.

I have had 4 HRA's (every 1.5 years) since I was diagnosed with low grade anal dysplasia (pre cancerous but not cancer)

There are guidelines around anal cancer and HIV, believe it or not. But many good doctors are referring long term HIV survivors to HRAs. Most wait until symptoms like anal bleeding, discomfort, and inflammation are present, though.

Anal dysplasia is caused by HPV, the human papilloma virus. There are two vaccines to prevent HPV in those who have not been exposed to the cancer producing types of HPV. But many of us have already been exposed. There are no current vaccines for those of us who have these HPV genotypes. So, monitoring is the best way to keep an eye on any progression of anal dysplasia. However, not a single study has proven if HRA plus infrared coagulation of suspect tissue is effective in the long term to prevent anal cancer. There is a large study being planned right now.

It seems that those of us who have been infected for a long time and those who had low CD4 cells in the past are a greater risk of anal cancer. Undetectable HIV viral load does not seem to protect us from progression. It is a very slow moving cancer, so it may take years to detect any progression. It affects tops, bottoms, men, women, gay or straight.

You may want to read a few of these old posts:

Who Gets Anal Cancer

and

Nelson's video on HPV

Let us know what you find out when and if you get a HRA done.

Nelson



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