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HPV & Anal Warts; is my CD4 count falling because of the warts?
May 16, 2002

I was diagnosed last week with anal warts and have already had surgery to remove them. My proctologist says that I had extensive warts all the way up into the base of my colon. I was diagnosed HIV positive last summer and had apparently been positive for quite a while. VL is undetectable. My CD4 count has been declining for the past few months however (march 2002 CD4 371, april CD4 307, may CD4 224). Could the fact that these warts were so prevalent be the reason for the CD4 count falling - and further, now that they have been excised, will my CD4 count bounce back? My proctologist indicates that I will need to see him frequently (once a week seems like a little much, would you agree?) to monitor the situation. I am very concerned about developing anal cancer, but if i keep the area clear of warts, will I eliminate the chance of developing the cancer? Sorry so many questions, but I have so many questions...

Response from Dr. Dezube

I'm glad to hear that you are getting this problem addressed. That's a good step.

Do the extensive warts explain a falling CD4 count?-- Probably not. I am not aware of any data which suggest that extensive warts cause a fall in the CD4 count.

Will you CD4 count bounce back?-- Your CD4 count may bounce back now that your viral load is undetectable. I'm not sure the warts or the treatment of the warts has anything to do with changes in your CD4 count.

Will you eliminate the chance of developing cancer? You won't eliminate the risk, but you will decrease the risk. At this point in time, HPV is not curable. You will remain HPV infected. Many many gay men are HPV infected, even though they may not have any evidence of warts. Having the warts removed as well as any high grade precancerous lesions removed will decrease the risk of developing cancer.

Do I agree that weekly examinations are excessive? Weekly examinations certainly do strike me as excessive. Is there a chance that I'm not hearing the whole story? How often should you be seen? It's hard to tell without knowing the specifics of your condition. Some of my patients with your condition are seen quarterly (every three months), some twice a year, and some at other frequencies.

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