Question

Hi Doctors. I'm recently infected then diagnosed with HIV (less than 4 months as of Nov 20/10). All my initial numbers are perfectly normal with CD4 437 at 26%, and my VL is 927 copies. I had a history of anal wart but had a cautery done to treat it about 2 years ago. I never followed up since the doctor said it should cure it after the treatment. Should I be concerned about long term potential of anal cancer? Should I be screened again and more regularly? Is there a blood test to determine or biopsy the only option to determine if the wart has gone away? This is for either Dr Young or Dr McGowan please. Sorry not sure what category I should pose this question so I did it here....

Answer

Thanks for your questiion, it is a timely one.

There is a virus called Human Papilloma Virus (HPV) that can cause anal warts. HPV has many different types (or strains), some cause warts but some can cause cancer. Usually the ones that cause warts do not cause cancer. But having 1 type may mean you have others as well. Infection with the wart causing types can come and go...infection with the cancer causing types usually persists. It can take many years for cancer to develop.

The best thing is to have screening for HPV and an anal pap smear (just like a cervical pap for women) for men who have had sex with men or women with abnormal cervical Paps. Since it usually takes years for cancer to develop we can find it early and prevent it. Unfortuantely there is no blood test, but the screening is not difficult and can be done by your HIV or primary care doctor.

Best, Joe