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Human papillomavirus (HPV) viral load and HPV type in the clinical outcome of HIV‐positive patients treated with imiquimod for anogenital warts and anal intraepithelial neoplasia
Author(s) -
Sanclemente G,
Herrera S,
Tyring SK,
Rady PL,
Zuleta JJ,
Correa LA,
He Q,
Wolff JC
Publication year - 2007
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/j.1468-3083.2007.02169.x
Subject(s) - imiquimod , medicine , viral load , anal cancer , clearance , lesion , dermatology , intraepithelial neoplasia , gastroenterology , human papillomavirus , human immunodeficiency virus (hiv) , cancer , pathology , urology , immunology , prostate
Objective To evaluate the efficacy of 5% imiquimod in HIV‐positive male patients with anogenital warts or anal intraepithelial neoplasia (AIN), and to elucidate whether human papillomavirus (HPV) type and viral load were important for clinical outcome and recurrences. Methods Thirty‐seven patients with histologically proven anogenital warts or AIN were enrolled. Topical 5% imiquimod was applied three times per week for more than 8 h overnight for 16 weeks, although patients were allowed to continue therapy for 4 more weeks if they did not have complete clearance of lesions. Results Mean age was 34 years. The perianal area was the main lesion location. Thirty‐three patients had CD4 counts of < 500 cells/mm 3 . Eighteen patients had a histopathological diagnosis of AIN‐1. Main HPV types detected corresponded to low‐risk HPV types. At 20 weeks of therapy, 46% patients achieved total clearance whereas 14 patients had > 50% clearance. Recurrence was observed in 5 of 17 patients who cleared. Clearance was not influenced by patients’ CD4 counts, wart location, HIV viral load or HPV viral load. Conclusions The assumption that visible perianal warts are benign lesions in HIV‐positive patients has to be reevaluated since an important number of such lesions could correspond to low‐grade anal disease, which in turn could progress to high‐grade anal disease or cancer. In addition, our results in this preliminary study indicate that imiquimod appears to be effective in treating AIN in HIV‐positive patients. Further studies are needed to document its utility to prevent high‐grade dysplasia and/or anal cancer.