Aggressively treat anal warts in HIV+ patients. (May Progress to Anal Cancer).

SAN FRANCISCO--Patients with HIV often have anal warts, which can be very difficult to treat, Dr. Toby A. Maurer said at a meeting on HIV management sponsored by the University of California, San Francisco.

But aggressive treatment is indicated, especially in patients who are noncompliant with highly active antiretroviral therapy (HAART) because anal warts may progress to anal cancer, said Dr. Maurer, a dermatologist at San Francisco General Hospital.

Studies have shown that 100% of patients with HIV have evidence of human papillomavirus (HPV) in the anal area, and the incidence of anal cancer is rising in these patients. As a result, an increasing number of physicians recommend anal pap smears, colposcopies, and biopsies to look for dysplasia and cancer, Dr. Maurer said.

If there is high-grade dysplasia, she recommends surgical excision to prevent invasive carcinoma. But she acknowledged that questions remain about how much tissue to take out and whether the surgery will rid patients ...