Anal Warts and HIV: Understanding the Increased Risk

Anal warts, caused by the human papillomavirus (HPV), are a common sexually transmitted infection that can affect individuals of all genders and sexual orientations. However, for people living with human immunodeficiency virus (HIV), the risk of developing anal warts and other HPV-related complications is significantly higher. In this blog post, we'll explore the link between anal warts and HIV, and discuss what individuals can do to protect their health and reduce their risk of complications.

How HIV Affects the Immune System

HIV is a virus that attacks the body's immune system, specifically the CD4 cells (also known as T cells) that help fight off infections and keep the body healthy. Over time, HIV can deplete these cells, making it harder for the body to defend itself against other infections and diseases.

When the immune system is weakened by HIV, it becomes more susceptible to opportunistic infections – infections that take advantage of the body's compromised defenses. HPV, the virus that causes anal warts, is one such opportunistic infection.

The Increased Risk of Anal Warts in People with HIV

Studies have shown that people living with HIV are more likely to be infected with HPV and to develop HPV-related complications, including anal warts and anal cancer. In fact, research suggests that:

1. The prevalence of HPV infection is higher in people with HIV compared to the general population.

2. People with HIV are more likely to be infected with multiple strains of HPV, including high-risk strains that are associated with an increased risk of cancer.

3. Anal warts are more common, more extensive, and more difficult to treat in people with HIV compared to those without HIV.

4. The risk of developing anal cancer is significantly higher in people with HIV, particularly in men who have sex with men (MSM) and those with low CD4 cell counts.

The exact reasons for this increased risk are not fully understood, but they are thought to involve a combination of factors, including:

1. Weakened immune response: With a compromised immune system, the body is less able to fight off HPV infection and prevent the development of warts and other complications.

2. Increased viral load: People with HIV may have higher levels of HPV in their bodies, which can increase the risk of transmission and the severity of complications.

3. Co-infection with other STIs: People with HIV are also at increased risk of other sexually transmitted infections (STIs), which can further compromise the immune system and increase the risk of HPV-related complications.

Protecting Your Health as a Person with HIV

If you are living with HIV, there are several steps you can take to protect your health and reduce your risk of developing anal warts and other HPV-related complications:

1. Adhere to your HIV treatment plan: Taking your HIV medications as prescribed can help keep your immune system strong and reduce your risk of opportunistic infections.

2. Get vaccinated against HPV: The HPV vaccine is safe and effective for people with HIV and can help protect against the strains of HPV that cause most cases of anal warts and anal cancer.

3. Practice safe sex: Using condoms and dental dams during sexual activity can help reduce the risk of acquiring new HPV infections or transmitting the virus to partners.

4. Get regular anal Pap tests: If you are a person with HIV, particularly if you are an MSM, your healthcare provider may recommend regular anal Pap tests to screen for precancerous changes in the anal canal.

5. Don't delay treatment for anal warts: If you do develop anal warts, it's important to work with your healthcare provider to develop an effective treatment plan. Prompt treatment can help prevent the warts from spreading or becoming more difficult to manage.

PARTNERING WITH YOUR HEALTHCARE TEAM FOR OPTIMAL HEALTH

Living with HIV and managing the risk of HPV-related complications can be challenging, but you don't have to do it alone. By working closely with your healthcare team, you can develop a comprehensive plan for monitoring your health, preventing infections, and treating any complications that may arise.

If you have concerns about anal warts, HIV, or your sexual health, contact me today to schedule a consultation. As a gastroenterologist with expertise in HPV-related conditions, I can provide the personalized care and support you need to feel your best and protect your long-term health.

Remember, with the right knowledge, tools, and support, you can thrive as a person living with HIV and enjoy a full and healthy life. Don't hesitate to reach out for the care and guidance you deserve.

A daily HIV prevention pill? Hmm...

This is causing a lot of controversy.  Some are saying it's a pill for "promiscuity" and poor self control, while others are saying it reduces the the chance of infection while also reducing overall costs to those infected. Share your thoughts...

-- Dr. Dale

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Daily HIV prevention pill recommended for those at risk

http://www.cnn.com/2014/05/15/health/truvada-hiv-recommendation/index.html?hpt=he_c2

By Saundra Young, CNN

updated 2:50 PM EDT, Thu May 15, 2014

(CNN) -- For years the message was simple: Use condoms to prevent HIV. But if you are at high risk of contracting the virus, health experts want you to consider an additional strategy -- taking a pill every day to reduce your chance of being infected.

New guidelines published by the Centers for Disease Control and Prevention say pre-exposure prophylaxis, or PrEP, should be taken daily by people who are at high risk for contracting HIV.

The recommendation is based on several large national and international studies, which were done in varying at-risk populations, such as gay and bisexual men, heterosexual couples where one person is HIV-positive (the other is not) and injection drug users.

The studies all showed that this drug can help reduce infection rates by more than 90% when taken daily.

"While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today," Dr.Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a statement.

"These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances."

According to the guidelines, those circumstances would be anyone who:

• has had sex without a condom;

• is not infected with HIV but is in a sexual relationship with an HIV-infected partner;

• is a gay or bisexual man who has had a sexually transmitted disease within the last six months and is not in a mutually exclusive relationship with a recently tested HIV-negative partner;

• is a heterosexual man or woman who does not always use condoms when having sex with partners already at risk, and who isn't in a mutually exclusive relationship with a recently tested HIV-negative partner;

or

• has injected drugs or shared drug paraphernalia in the past six months

In 2012, the Food and Drug Administration approved Truvada, a pill that combines two antiretroviral drugs for the prevention of HIV. It was first approved in 2004 as an HIV treatment and is still the only FDA-approved medication for PrEP.

Truvada isn't cheap. A month's supply can cost you anywhere from $1,300 to $1,700, according to Drugs.com. But insurance may cover the bill.

To be effective, this pill must be taken every day.

Dr. Anthony Fauci, an immunologist who has been at the forefront of HIV/AIDS research for decades, called it a highly effective approach to preventing the spread of the virus that causes AIDS.

"(It's) one that benefits not only the individual patient at risk for HIV infection but also will help to reduce the number of new HIV infections across the United States," said Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. "It should be used together with -- and complementary to -- condoms and not as a substitute for condoms."

The new guidelines replace interim ones published two years ago; they provide a comprehensive place where doctors and patients can find information on PrEP and come with a supplement that provides checklists for physicians, giving them step-by-step support for dealing with patients who might be considered for prophylactic treatment.

"PrEP is a new approach to HIV prevention that requires continuing collaboration between patients and providers, as effectiveness requires adherence to daily medication and regular medical visits for monitoring, counseling and testing," said Dr. Dawn K. Smith, an epidemiologist in CDC's Division of HIV/AIDS Prevention who led the development of the guidelines.

"Individuals will have to decide with their doctor if PrEP is right for them, but for some, this may offer a much-needed strategy to help protect themselves from HIV infection."

There are 1.1 million people in the United States living with HIV, according to the CDC. An estimated nearly one in six do not know they're infected.

Men who have sex with men are the hardest hit -- while they make up 2% of the U.S. population, they account for 63% of all new infections each year, according to the CDC. Heterosexuals make up 25% of all new annual infections; 9% are injection drug users.

"HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States," said Dr. Tom Frieden, the CDC's director, in a statement. "PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the United States."