A man in his 50s presented with painful lesions located on the anal margin. He was HIV positive since 1996. He was treated by a regimen of bictegravir, emtricitabine, tenofovir and alafenamide. The CD4+ lymphocyte count was more than 500 per x10ˆ9/L millimetre with a negative HIV viral load. He had been treated for low-grade human papillomavirus (HPV)-related lesions of the anus in 2018 and was subsequently lost to follow-up. Examination showed cauliflower-like lesions associated with some painful erosions (figure 1A). Anoscopy was normal. …