Questions and Answers with NAM
Chris Gadd, editor HIV & AIDS Treatments Directory
Warts and all
Išve just been diagnosed with genital warts. What are they and why do I
have them?
Warts are small growths on the skin or in the genital area. They can occur
anywhere on the body. All warts are caused by HPV (human papillomavirus).
Some types of HPV are passed on during anal, vaginal or oral sex. These strains
can lead to warts growing on the penis, in and around the back passage, or,
in women, on the cervix (the neck of the womb) and the vulva. Genital warts
are the most common type of sexually transmitted infection, accounting for
around a fifth of all diagnoses. Some people with HPV may have no symptoms,
or they may not notice they have warts at all.
Will HIV make my warts worse?
Possibly. Infection with HPV is more common in HIV positive men and women,
especially in people with low CD4 cell counts or high viral loads. Warts can
grow larger and recur more quickly in people with HIV. HPV can sometimes lead
to certain genital cancers, including cervical or anal cancer. These are more
likely in HIV positive people, as the virus may be reactivated in people with
damaged immune systems.
Does that mean I will get cancer?
Not necessarily. Only some strains of HPV lead to cancer, so you shouldnšt
assume you will end up with the disease if you have had genital warts. And
some peoplešs precancerous lesions (dysplasia or intraepithelial neoplasia
or lesion) remain stable and do not progress to invasive cancer. Itšs important
to realise that anal cancer develops very slowly and, with regular check-ups,
you can ensure warts or precancerous growths are picked up and treated sooner
rather than later. Women are automatically offered a Pap smear when diagnosed
with HIV, again after six months and then at yearly intervals. This involves
taking a small scraping of cells from the cervix and looking at them under
the microscope for signs that they might turn into cervical cancer. Some doctors
think that similar screening should be offered to HIV positive gay men, to
look for precancerous cells in the anus. However, this is not yet offered
routinely.
Will HAART help my warts clear up?
Unfortunately, it looks like HAART only has a minor effect on HPV and the
progression to anal or cervical cancer, even when the drugs help to restore
the immune system. But there are a number of treatments available. These include
freezing them off with liquid nitrogen or burning them with a laser. They
can also be painted with chemicals like podophyllin resin (Warticon) or imiquimod
cream (Aldara), which you apply yourself. Imiquimod helps your body to fight
off HPV, rather than killing the warts directly, so it can be a more effective
treatment in some people. However, some doctors are concerned imiquimod is
not as effective at treating warts in people who have HIV. Surgery can be
used to remove any persistent warts. However, this is often a last resort,
when other treatments have failed or if the warts are very large.
And what if I have a pre-cancer? Can tha be treated?
We don't know yet what are the best treatments for pre-cancers caused by HPV.
However, a number of approaches are currently being tested, including imiquimod
cream. These pre-cancers normally progres to cancer slowly, but it is wise
to make sure you are assessed regularly, to keep an eye on how things are
going. If the lesions do progress to the early stages of cancer, they can
be treated similarly to warts or by surgical removal of the affected area.
More serious cancer is treated with surgery or a combination of local radiotherapy
and chemotherapy. Luckily, genital cancers are usually treated successfully,
particularly if they are caught early.
NAM provides information to help you think about your use of HIV treatments,
but this is not intended to replace discussion with your doctor.
