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Verruca treatment in patients with HIV.

Discussion in 'General Issues and Discussion Forum' started by erinbeeler, Feb 15, 2008.

  1. erinbeeler

    erinbeeler Member

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    HIV and VP

    Can anyone help?
    Today I had a male patient present with a VP, 3mm x 4 mm on the medial side of his heel. He is HIV positive, no other significant medical history, and would like it treated. He noticed it only 3-4 months ago but it has been bothering him ever since.
    I was wondering if anyone has any ideas - will any treatment work? Or due to the HIV is it likely to linger forever - ie am I fighting a losing battle attempting to treat this? His GP referred him to me for treatment. I have one colleague who says go for it and the other colleague convinced nothing will work. Thanks for your help :bash:
  2. Admin2

    Admin2 Administrator Staff Member

  3. Cameron

    Cameron Well-Known Member

    Re: HIV and VP


    A potential problem is a poor immune response which would likely extend the natural life of the viral infection/wart. Depending on the patient's general health, physical therapy with the usual modalities and chemical care may be contra-indicated. I have used a herbal preparations to great success on children with severe paralysis where skin breakdown was not possible. If you are interested have a read through the 'Duck tape does not work' thread and look for reference to kalanchoe.

  4. distalphalanx

    distalphalanx Member

    Hello everyone, i am looking for advice for the treatment of a patient with HIV who recently came into clinic. As a newly qualified pod working as an associate in a private practice the main and usual treatment for verrucas is with acids and cryo. But when i was faced with my first HIV patient my obvious concern was causing more damage than good and i was reluctant to treat with anything more than sharp debridement. On speaking with a colleague, it was suggested i should have used salicylic acid. I presume treating someone with a verruca that is also immunosuppressed is going to be an almost impossible task if possible at all, so is there any point in using acids or cryo and in this case would the risks outweigh the benefits??????????? HELP :sinking:
  5. Mark_M

    Mark_M Active Member

    From my experience with HIV patienbts they are prone to verruca's. As their disease progresses the more susceptible they are and they tend to multiply.

    If your patient is otherwise in good health I would treat it (get it early) , If their immune system is not intact that will be a pointless exersise in my opinion.
  6. erinbeeler

    erinbeeler Member

    Hey Distalphalanx,
    I agree with Mark. In regards to the patient I was asking about (see first thread) I ended up going for it with cryo. I told patient from the outset everything I had read (including responses here) and he was keen to try the cryo treatment. It took several goes, but we got there in the end. In his case, he was in excellent health otherwise. He called me a few months after treatment to let me know he had been watching closely, and as yet it (or others) have not come back. Good luck with your patient, and let us know how you go :D
  7. distalphalanx

    distalphalanx Member

    Hi Mark, thanks for the advice. The patient in question has net been into clinic since 2006 he was HIV positive then and at that time the verruca was not present. He has been having treatment in an NHS clinic but they were only debriding. The VP is about the size of a 5 pence piece and is well established. I couldn't comment on the patients health, but he tells me he is using drugs (illegal) and thats how he has contracted HIV. I was concerned that it would be fruitless but think if he comes back and wants to try, i will give it my best shot. Thankyou :drinks
  8. distalphalanx

    distalphalanx Member

    Hi, thanks for your help, yes i think i will give it a go if he comes back, i dont know about his general health, he didn't look great, but i could phone the Gp to ask advice on this also. He asked for treatment but was not very clear on previous treatment. He said he had tried cryo, sal acid with us before but there was nothing in his records and he had only had three previous treatments for general foot care. I will discuss the treatment next time he comes and see what we can come up with but i suspect his immune system is not good. thanks again, Jo :D
  9. toughspiders

    toughspiders Active Member

    Personally i dont think i would treat it. IMO why does he have it??? Answer , probably due to compromised immune system. I wouldnt like to be dealing with a wound in a HIV . The wart wont kill him but a wound could. Im with toe slayer id go with something less aggressive, debridement, homeopathy, duct tapes blah blah. I guess its one of those "its your call" things.
  10. Julian Head

    Julian Head Active Member


    have you asked for a cd4 count? That way you can tell how immuno-comprimised the patient is.....it is used to decide when to commence oral combination therapy.

    see this link: http://en.wikipedia.org/wiki/CD4

    Hope this helps


    ps as long as the cd4 count is normal why wouldn't you treat this patient?
  11. distalphalanx

    distalphalanx Member

    Hi Julian, thank you for your post i didn't know about the cd4 count so if the patient comes back to me i will request this from his GP. The only reason why i didn't treat is that i was concerned that i may do more damage than good and that the patient hadn't been to see us for 4 years previous so that may happen again and i wouldn't have been able to follow up on his treatment. Hopefully he will come back again and i can try to help next time. Best wishes, Joanna .:morning:
  12. NewsBot

    NewsBot The Admin that posts the news.

    Human Papillomavirus Types 2, 27, and 57 Identified in Plantar Verrucae from HIV-Positive and HIV-Negative Individuals
    Christy M. King , DPM, James S. Johnston , DPM, Kene Ofili , DPM, Maylynn Tam , DPM, Joel Palefsky , MD, Maria Da Costa , MS, Yasha Mathur , BS, Peter Barbosa , PhD
    Journal of the American Podiatric Medical Association: March 2014, Vol. 104, No. 2, pp. 141-146.
  13. NewsBot

    NewsBot The Admin that posts the news.

    Human Papillomavirus Types 2, 27, and 57 Identified in Plantar Verrucae from HIVPositive and HIV-Negative Individuals
    Christy King, DPM, James Johnston, DPM, Kene Ofili, DPM, Maylynn Tam, DPM, Joel Palefsky, MD
    Maria Da Costa, MS, Yasha Mathur, BS, and Peter Barbosa, PhD
    NYCPM; 2014
  14. NewsBot

    NewsBot The Admin that posts the news.

    Reduction in Size and Number of Plantar Verrucae in Human Immunodeficiency Virus–Infected Individuals After the Implementation of Highly Active Antiretroviral Therapy.
    Endri Afesllari, Timothy J. Miller, Michael J. Huchital, Christy M. King, James S. Johnston, and Peter Barbosa
    Journal of the American Podiatric Medical Association: September 2015, Vol. 105, No. 5, pp. 401-406.

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