Treatment Options for High-Grade Anal Dysplasia (Editor's Pick)


Hello Nelson, thank you for all of your helpful information. I have been on treatment with an undetectable viral load for five years, but my CD4 count fluctuates between 130 and 180, percent 14. I have seen a colorectal specialist for three years. In the first two annual biopsies, I had only one moderate dysplasia and a few labeled "mild". Then six months ago all hell broke lose, I had three high-grade areas show up which were burned/ablated. Two weeks ago, three more high-grades popped up. I'm concerned about the spot-checky nature of marinating the area in vinegar to decide what should be biopsied and afraid that it will progress to cancer faster than the biopsies will show. What advice can you give me? How often should I be biopsied and is there anything that can more completely check the entire area? Thanks


I am sorry to hear. Like you, I get checked annually and had anal dysplasia treated with infrared coagulation.

I would warn that doing frequent infrared coagulations or treatments in the anal canal can cause build up of scar tissue. This scar tissue can also confuse doctors during the next exams since they shine very much like pre cancerous cells once they are exposed to vinegar (under infrared light, vinegar makes precancerous or cancerous cells shine differently).

I have seen a lot of abuse in this area with "butcher doctors" who happily want to be aggressive. My insurance company was charged 26,000 dollars for my last treatment, for instance.

Some encouraging studies show that dysplasia can reverse on its own in some patients. I just warn patients to carefully discuss monitoring dysplasia versus treating it right away.

Here is a lecture I gave in San Francisco on the subject:

Anal dysplasia lecture by Nelson vergel

Here are some previous questions on the subject that you should read:

Previous post on anal cancer

question regarding HPV / dysplasia

Anal Cancer - Should I be concerned?

Please feel free to keep asking more questions. This is a subject matter that we are not discussing as much as we should as we age with HIV!