Dear Dr Feinberg

I have been treating anal warts consistently for the past three years. Usually with condaline but also padophyllin, liquid nitrogen, and also surgery. At one stage I had over 80 anal warts. Currently my viral load is about 7,500 and my CD4 is around 350. I have been HIV for 16 years, and in 89 had a major battle with non-Hodgkins lymphoma. Apart from the anal warts I am currently experiencing good health and have been on ritonavir/3TC/stavudine for 3 years. As you can imagine I'm starting to get a bit bored with having a "pain in the arse" ('scuse my French), and as I am a dancer/choreographer, this particular indisposition makes my work rather painful, and I was wondering if there are any other treatment options that might help to lower the ability of the HPV to continue to manifest. I did try DNCB for about a year, and it is possible that that had some positive effect, though it is now difficult to obtain in New Zealand. I realize that there is no cure for the virus, but am keen to look at options other than just removing the warts. Any ideas? Kind regards

When warts are still relatively small, a topical medicine called imiquimod works pretty well. You have to use it 3 times a week for usually 2-3 months. Interferon preparations have also been used, but these have to be injected and cause a fair amount of side effects in many people. And then there is always the burn 'em, freeze 'em, cut 'em off approach that you're bemoaning. I suggest you and your doctor give the imiquimod a try.