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anal HPV
Aug 7, 2004

Hi Handsome, Doc that is-- what is the latest low down on anal HPV in HIV poz men . I had some atypical cells when I requested an anal smear but think I was recovering from a recent bout of HSV. I know and can feel a wart and am using Aldara externally. How aggressive are you with anal smears want type of treatment are you recommending and when . Last number with Tcell count 1900, 38% and 100% compliantand not having any anal intercourse ever again. Thanks

Response from Dr. Wohl

There is plenty of variability in the use of anal pap smears in standard HIV management. Some physicians do it and some don't. Part of the decision to make these part of routine care has to do with having a collaborating pathologist who can read the smears and surgeons who can act when necessary.

I have to say, where I practice we have not had much success in launching a comprehensive program for anal pap smears in men and women. We are revisting this issue and after the World AIDS Conference discussed this again. Therefore, I am hardly an expert in the use and interpretation of these smears.

At the conference a study from San Francisco was presented in which 417 HIV+ men were screened with anal pap smears every 6 months. 54% had abnormal smears and 1% had anal carcinoma at entry. 190 had anal paps and anoscopy with biopsy. Pap smear results of ASCUS (atypical squamous cells of uncertain significance) frequently lead to HGSIL (high-grade squamous intraepithelial lesion) on anoscopy and biopsy.

I would recommend a repeat smear be done. There can be a number of reasons for the atypia seen including those you mention.

DW



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