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Anal warts? Also, any info on T20?
Jul 25, 2000

Hello Docs!

Two questions. First, can you give me a definitive description of anal warts, what they look like, how big they generally are, location, etc...

I have recently noticed two tiny bumps around my anal area. In fact, they are VERY tiny. I had thought they were in-grown hairs or pimples, but now I'm sure they're not (because they are still there 3 months later) no bigger, but still there.

I have been acquiring small, wart like bumps,(5) predominantly on the back of my hands and fingers. My doctor gave them a name, but I forget what it was. In any case, he said they were nothing to worry about. (something about naturally dying skin cells that don't fall off and build up layers instead?) These bumps I have around my anus appear to be the same type of thing. Don't anal warts progressively get larger?

I was having trouble getting my VL down to "undetectable" for the last 2 years (Initial VL in '98 was 110,000 and CD4 @ 85. never got below 135 and T's hovered around 300) I'm finally on a combo (Viramune, Zerit, Ziagen) that has my VL "undetectable" and my T's have shot up into the mid 400's. Funny thing is, these "bumps" have appeared since I've become undetectable. Any thoughts?

Also, I've heard in the past about a new drug called T20 that was being clinically tested. Recently, I heard on the news that it has been approved and the report sounded very positive.

What category does T20 fall into? (nukes, non-nukes...) or is it in a class of it's own? How does it affect the virus? Is it an alternative to failing meds (not that I'm in that position yet...Just want to stay informed)

Thanks for your help and advice. You're an invaluable resource for information and are GREATLY appreciated.

Response from Dr. Pavia

Anal warts are generally flat topped, hard bumps. If one looks at them closely, say with a magnifying lens, they have what we call a "cauliflower-like" surface, not unlike regular warts. They usually continue to grow, but the rate is very variable - ranging from very fast to very slow. The first step in finding out is to have someone (like your doctor or a dermatologist) take a close look. Sometimes, applying acetic acid (ie vinegar) for several minutes will make warts stand out, but not other types of lesions. The "gold" standard (sorry) is to biopsy them.

Congrats on doing so well on your current regimen. Keep up the good work.

T20 is a new type of drug - an inhibitor of HIV entry into cells. It has to be injected twice a day, making it most useful when all else seems to be failing. The famous doctor Cal Cohen (you know, the one who writes here) presented the one year results of a preliminary study for people failing most everything else. It seemed to provide benefit for those who could stick with it.

T20 has a ways to go before final approval. The major trials, called phase 2-3 trials, will be starting shortly. Despite the limitations, it is great news to have a whole new class of drugs to work with.


Andrew T. Pavia, M.D.

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