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intraepithelia neoplasia/HPV disease, surgery, and now what?
Mar 31, 2002

dear doctor, I recently asked you a question about intraepitelial neoplasia (cancer) due to HPV (human papilloma virus) and I really appreciated your answer. Well I have had the small lip of the vulva removed by surgery, but it seems that the white patch is back again. I have heard that pegylated interferon could do well for me, but I worry because my CD4 cell count is 250, and a long period treatment with interferon could lower my CD4. Do you have any suggestions about the treatment I should follow? my best regards from Spain

Response from Dr. Dezube

Dear Spain: I'm glad you had the surgery. Your disease is best managed by surgery. Is your surgeon interested in removing the white patch? Is it felt that the white patch is related to your HPV (human papilloma virus) disease? Although interferon is somewhat active against HPV disease (warts), it can cause strong side effects and for this reason I reserve its use for patients with severe HPV disease. I use interferon in this setting very infrequently. Currently HPV vaccines are in trial and I imagine that eventually this may be the best approach. Also Aldara cream is very effective against HPV disease. Although Aldara is used more for HPV warts than for HPV intraepithelial neoplasia, some providers try it for both conditions. Given it's ease to use, you could try it. You would need to apply it 2-3 times per week. Apply at night and wash off in the morning.

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