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HIV and Anal Fissure, Etc.
Oct 5, 2005

I read that people with HIV and a low CD count or weak immune system can be susceptible to anal fissures. If such a person has both an anal fissure and a tear in the gum of the mouth that occurred for no apparent reason, could there be a relation to both? If so, what condition could that be and what would be the treatment? Aside from surgery, what can a person do to help heal a stubborn fissure besides the usual home remedies? I had a colonoscopy last year, and several weeks later the anal fissure occurred. If the fissure was due to anal cancer, wouldn't they have noticed cancer during the examination? A doctor told me that as my CD count goes back up, the anal fissure may go away on its own since my body will be better and stronger at dealing with all sorts of things. I've had mine for nearly a year, but my CD4 count is on the slow rebound. Any information and/or suggestions will be appreciated. Thanks!

Response from Dr. Pierone

Hello and thanks for posting. There is a greater prevalence of anal fissures in people living with HIV infection. Anal pathology is commonly misdiagnosed or under diagnosed in the context of HIV infection multiple conditions may co-exist. Chronic herpes simplex infections, papilloma virus infections, hemorrhoids, and peri-anal fistula are some of the conditions that may occur. The change in bowel patterns related to HIV or treatments also contributes to the development of anal and rectal problems.

Chronic anal fissure (and yours qualifies) can be treated with topical therapies such as nitroglycerin or calcium channel blocker gels. Interestingly, botulinum toxin Botox (yes Botox) injections work in many cases. When these measures are ineffective, a surgical procedure internal lateral sphincterotomy generally does work.

The bottom line is that you should be evaluated by a physician experienced in the diagnosis and management of anal fissure. Good luck and let us know how this turn out!

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