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hpv infection (HPV, HUMAN PAPILLOMA VIRUS AND HIV/AIDS, 2010)
Dec 10, 2010

hello Dr. Frascino, I know that HIV is more your area of expertise but I was wondering if you knew anything about hpv. I was diagnosed with hpv about 10 years ago and was reading recently that some percentage of people actually clear the infection, as well as the actual warts, from their body. Recently I had a partner of mine absolutely freak out because I conveyed to him that I didnt think it was that big of a deal, especially considering everything that's out there today. Regardless, I was wondering if it is true that some or most people actually clear the infection form their body. Perhaps if it is true this may give some consolation to my partner in the hopes of not contracting my hpv. Thank you...wishing all the best.

Sincerely, Anonymous

Response from Dr. Frascino

Hi Anonymous,

There are many different types of HPV (30-40 varieties). Over half of all sexually active folks become infected with some type of HPV. In 90% of these cases the body's immune system completely clears the infection. (See below.)

Hope that helps.

Dr. Bob

Human Papilloma Virus (HPV) and HIV/AIDS April 2010

What Is HPV?

Human Papillomavirus (HPV) is the name of a large group of viruses. Certain types of HPV cause warts on the hands or feet. About 30-40 types can cause infections in the genital area (the vulva, vagina, penis, buttocks, scrotum, and anus).

Genital HPV types are often referred to as "low risk" and "high risk." Low-risk types can cause genital warts. High-risk types can cause cervical cancer or cancer of the vulva, vagina, anus, and penis.

The types of HPV that can cause genital warts are not the same as the types that cause cancer. However, if you have warts, you may have also been exposed to the types of HPV that could cause cancer.

Genital HPV is spread easily through skin-to-skin contact during vaginal or anal sex with someone who has the infection. Condoms do not totally prevent transmission. Even though many people who have HPV don't know it, they can still pass it on to someone else.

Genital HPV is the most common sexually transmitted disease (STD) in the US. Over 50 percent of all sexually-active men and women become infected with HPV at some time in their lives.

Most people with HPV do not know they have it because they do not develop symptoms. In 90 percent of cases, the body's immune system clears HPV infection naturally (without treatment) within two years.

People living with HIV (HIV+ people) are more likely to be infected with HPV than HIV-negative people. HIV+ people with HPV are also more likely to develop genital warts, as well as cervical or anal cancer.

If you have sex, it is important to be checked for signs of HPV such as genital warts or cervical and anal cancer. This is because the body does not always clear HPV on its own and you may need treatment to prevent health problems.

Genital Warts

Certain types of HPV can cause warts on the vulva; in or around the vagina or anus; or on the penis, scrotum, groin, or thigh. Warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. They can even appear years after exposure.

Symptoms

Flesh-colored, pinkish, or white warts that appear as small bumps or groups of bumps. They can be raised or flat, different sizes, and are sometimes shaped like cauliflower. Diagnosis

Health care providers can usually identify genital warts by looking at them Sometimes a biopsy is done (a sample of the suspected wart is cut off and examined under a microscope) Some health care providers may use a vinegar solution to help identify flat warts, however, this test may sometimes wrongly identify normal skin as a wart Treatment

There is no cure for HPV, but genital warts can be treated by removing the wart.

The following treatments must be done in a health care provider's office: TCA (trichloracetic acid): A chemical is applied to the surface of the wart Cryotherapy: Freezing off the wart with liquid nitrogen Electrocautery: Burning off the wart with an electrical current Laser therapy: Using an intense light to destroy the wart Excision: Cutting the wart out Some treatments can be done at home with prescription creams Do not use over-the-counter wart removal products to treat genital warts Some wart treatments should not be used by pregnant women Warts can reappear after successful treatment If left untreated, genital warts may go away, remain unchanged, or increase in size or number. Some people decide not to have treatment right away to see if the warts will go away on their own. When considering treatment options, you and your health care provider may take into account the size, location and number of warts, changes in the warts, your preference, and the side effects of treatment.

Many HIV+ women, especially those with low CD4 cell counts, may not be able to get rid of genital warts using standard treatments. Several different treatments may be needed.

Dysplasia and Cervical Cancer

Certain types of HPV can cause abnormal cells to form. This is called dysplasia. The main place dysplasia occurs is on the cervix. Other less common areas are the vagina, vulva, and anus. Dysplasia is not cancer, but if left untreated, it can develop into cancer.

Cervical cancer can be life threatening. It is one of the few AIDS-defining conditions specific to women. Fortunately, it can be prevented through early diagnosis and treatment.

Cervical cancer screening is done by using a Pap test (sometimes called a Pap smear). This test checks for changes in the cervix. Cervical cancer usually takes years to develop, but it does not have symptoms until it is quite advanced. This is why getting screened on a regular basis is important; screening can catch potential problems before they get worse.

It is especially important for HIV+ women to have regular Pap tests. This is because HIV+ women are more likely to have abnormal Pap tests than HIV-negative women.

Symptoms

Many women do not experience symptoms In very advanced stages, a woman may experience pain, vaginal discharge, and bleeding between periods Diagnosis

HIV+ women should have a complete gynecological examination, including a Pap test and a pelvic exam, when they are first diagnosed or when they first seek prenatal care HIV+ women should have another Pap test six months later If both tests are normal, yearly screening is recommended An abnormal Pap test can indicate inflammation, infection, dysplasia, or cancer If you have an abnormal Pap, you may need a colposcopy (an exam of your cervix using a magnifier to look at the tissue more closely) and a biopsy (cells or tissues are removed so they can be checked under a microscope for signs of cancer) An HPV test can be used along with the Pap test to detect cancerous and pre-cancerous conditions. However, there are no firm recommendations for using the HPV test in HIV+ people. Speak with your health care provider to see if the HPV test is appropriate for you. Treatment for Dysplasia

If it is determined that you have dysplasia, discuss your treatment options with your health care provider. While there is no cure for HPV, dysplasia can be treated. Most treatments focus on destroying the abnormal tissue so that it doesn't progress to cancer.

Electrocautery Burning off the cells with an electrical current Laser therapy: Using an intense light to destroy the cells Cold-knife cone biopsy: Cutting the cells out LEEP: Loop electrosurgical excision procedure Cryotherapy: Freezing the cells with liquid nitrogen In cases of mild dysplasia, your health care provider may just monitor the cervix by colposcopy, repeat Pap, or HPV test Dysplasia is more common in HIV+ women than HIV-negative women, especially women with advanced HIV disease and low CD4 cell counts. Dysplasia is often more serious and difficult to treat in HIV+ women than HIV-negative women.

Treatment of Cervical Cancer

Cervical cancer is most treatable when it is diagnosed and treated early, so regular Pap tests are vital. Treatment depends on the type of cervical cancer and how far it has spread. Often, more than one kind of treatment is used.

Surgery: Cancer tissue is cut out in an operation Chemotherapy: Drugs (pills and/or intravenous medications) are used to shrink or kill the cancer Radiation: High-energy rays (similar to X-rays) are used to kill the cancer cells

Dysplasia and Anal Cancer

Nearly all HIV+ men with a history of receptive anal intercourse have anal HPV infection. Certain strains of HPV may cause dysplasia and cancer in the anus. Although the risk of developing dysplasia is higher among men who have sex with men, women are also at risk, especially those with HIV or who have had anal intercourse.

Symptoms

May be no symptoms Anal bleeding, irritation, itching, or a burning sensation In very advanced stages, there may be abscesses, lumps, ulcers, and anal discharge Diagnosis

Careful physical examination by a health care provider may be the best way to detect anal cancers An abnormal anal Pap test may indicate dysplasia or cancer If you have symptoms, you may need an anoscopy (an exam of the anus using a magnifier to look at the tissue more closely) and a biopsy (cells or tissues are removed so they can be checked under a microscope for signs of cancer) It is important to ask your health care provider to check for anal cancer on a regular basis Treatment

Same as treatment for dysplasia and cervical cancer (see section above)

HPV is More Common and Can Be More Serious for HIV+ People

HIV+ people are more likely to be infected with HPV than HIV-negative people. One study found HPV in more than 3 out of 4 HIV+ women. Because of immune suppression, HIV+ women are more likely to have:

HPV infection that does not clear up on its own Infection with the HPV strains that are more likely to cause cancer Higher risk of developing cervical cancer HPV in both the cervix and anus Several strains of HPV at once HPV infections that were previously under control that come back again HPV that responds poorly to standard therapies -- multiple treatments using different methods may be needed

Prevention of HPV

Vaccine

There are two Food and Drug Administration (FDA)-approved HPV vaccines: Merck's Gardasil and GlaxoSmithKline's Cervarix. Gardasil is approved for females and males ages 9 to 26. Cervarix is approved for females ages 10-25. Pregnant women should not use the vaccines. Both vaccines protect against types of HPV that cause the majority of cervical cancer cases and genital warts.

It is important for young people to get vaccinated before their first sexual contact (before they have been exposed to HPV). People who are already infected with HPV are not protected by the vaccines. Also, the vaccines do not protect against less common HPV types. Therefore, health care providers still recommend regular Pap tests to look for dysplasia before it becomes cancer.

There are payment assistance programs for people who cannot afford the HPV vaccines, see the resource section of this sheet for contact info.

The safety and effectiveness of the vaccines in HIV+ people has not been determined. Speak to your health care provider about the HPV vaccine to see if it is appropriate for you.

Routine Screenings

Regular pelvic and anal exams and Pap tests are very important. While they cannot prevent HPV-related problems, they can help catch warts and dysplasia before they progress and cause greater problems.

It has been found that many HIV+ women skip PAP tests. It is crucial that HIV+ women get routine Pap testing and follow up as needed to identify problems before cancer develops. Prevention is always better than treatment.

Condoms

Even though condoms do not fully protect HPV, when used correctly, they can help reduce the risk of HPV transmission.

Not Smoking

Smoking has been shown to increase the chance of developing numerous types of cancer including cervical and anal. If you smoke, it is a good idea to try and quit.

Taking Care of Yourself

HPV can be very serious for HIV+ people. Since there are frequently no symptoms, regular monitoring by your health care provider is the best way to be sure that any problems are found and treated before they progress.

A recent study also found that HIV+ women who were adherent (stuck closely) to their HIV drugs and had an undetectable viral load, had lower levels of HPV and were less likely to have pre-cancerous cervical cell changes. Although more research is needed, these findings suggest that sticking to an effective HIV drug regimen may help reduce HPV-related problems.



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