Mar 2, 2001
Dr, I am a 35 year old HIV+ male, diagnosed 4/90 w/1000+ CD4's at the time, currently 500-600 CD4's and a viral load below 5,000. I was treated prior to HIV infection for anal condyloma (6+ years prior) and have recently discovered they're back. The pathology report determined there was a presence of stage 1 and stage 2 AIN cells and the physician believes I should take part in a procedure called, "anal mapping". What can you tell me about this procedure? How significant is the presence of stage 2 cells, and how quickly should I respond?
Response from Dr. Dezube
The bottom line (sorry for the pun) is that I do think you should have the AIN 1 and 2 taken care of. AIN stands for pre-anal cancer; the cancer cells have NOT yet broken through the membrane. This is good news in that the cancerous cells have not spread yet. Given your high CD4 count, the AIN cells will in time progress. If you had just AIN 1, I would recommend just having a repeat look in your anal region in another 6 months. Often AIN 1 lesions will go away by themselves. However, AIN 2 lesions tend to progress. Although different clinicians will mean different things with such terminology by anal mapping, what you should have done is an anoscopy (someone looking up your canal) to document the extent of your disease, and then surgery to remove it. Often lasers are used to burn the base of the lesions to prevent them from coming back. Aldara cream is very effective against anal warts. Sometimes if the AIN lesions are close to the opening, you can apply Aldara cream internally using a hemorrhoid medication applicator (Note that this use of Aldara cream is not improved). There is NOT a sense of urgency. I would recommend at this point anoscopy and possible surgery sometime in the next few months. GOOD LUCK.
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