question regarding HPV / dysplasia

Question

Nelson - first of all, since being diagnosed a year and a half ago, I have found you to be completely inspirational and deeply helpful to so many of us. Thank you for all you do!

I have HPV and have had 2 high resolution anoscopy's in the past 18 months. The second one revealed a "very small, low grade dysplasia". The provider prescribed Aldera and scheduled another HRA in 6 months. He said that a great majority of dysplasia's clear on their own, and that even if they do not, it is only a very small (less than 5%) which turn cancerous. He said that they simply monitor the dysplasia and if it is not clearing on its own (with the Aldera) or if it is getting worse, then they treat it with I believe an infrared laser treatment, etc. I then asked him what the chance was of cancer after that. According to him - if I am consistent with my HRA's - he said there is "theoretically 0% chance of cancer". In other words - it is only those who are unaware or not consistent with monitoring who end up having trouble long term.

Can you please comment on this? I have a tendency towards anxiety disorder, so I am concerned he is "downplaying" something more serious. At the same time - I am very diligent about my appointments, etc. By the way - I was diagnosed extremely early so I always had excellent counts. My VL was only 400 and my CD4s were 900 when diagnosed. I went almost instantly UD and my CD4s have been around 1200 since then.

How worried should I be about this turning into cancer? Or if it is monitored and consistently treated, should I be fine?

Thank you so much.

Answer

Your doctor is right. We are seeing emerging data that shows that we should probably be more conservative with low grade anal dysplasia. In fact, I wish I had seen this new data 6 years ago before I got three infrared coagulation therapies (IRC) that created a lot of scar tissue in my anal canal.

Aldera works pretty well for mild cases. It can be irritating since your immune system is activated in the local area.

You may want to read this info to educate yourself and decrease your anxiety level:

Anal lesions often resolve without treatment in HIV-positive gay men

Previous question answered by Nelson Vergel

I hope this helps!

Nelson