Dear Dr. Reznik:

I'm a person living with HIV under HAART treatment, and currently my viral load is undetectable and my CD4 count is 450. My doctor has told me I have a HPV lesion in my mouth, next to the throat opening. Although it does not cause me any pain, I would like to have it removed. Aside from surgery or freezing with liquid nitrogen, I wonder if you believe treatment with imiquimod (Aldara) would be effective. I appreciate your advise.

Imiquimod 5% cream is a new compound which modifies the immune response by stimulating the production of interferon alpha and other cytokines. It has shown remarkable promise in the treatment of external genital and perianal warts when applied overnight, three times a week. It is also associated with a lower recurrence than those found with other current treatments.

I am not aware of any intraoral trials with this new medication which is indicated for the treatment of external warts. We have had excellent success utilizing cryotherapy for intraoral lesions. To see how we utilize this technique, please visit the following URL: http://www.hivdent.org/slides/cases/csindex01.htm

The advantages to cryotherapy are as follows:

1. not nearly as painful as more intrusive procedures such as surgical removal and laser therapy. We only use minimal anesthesia and rarely have to write for pain medications

2. recurrence seems to occur less with this technique.

I hope this information proves helpful!

DR