Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients.
OBJECTIVE
To evaluate the efficacy of surgical-cidofovir (SCT), surgical (ST) and cidofovir (CT) treatment of genital warts in HIV-infected patients.


METHODS
Open randomized prospective pilot study.


METHODS
Outpatients attending the sexually transmitted disease service of the II Dept of Infectious Diseases, L Sacco Hospital, Milan-Italy.


METHODS
Consenting HIV-positive patients with anal-genital warts recruited from January 2000 to March 2001.


METHODS
Three treatment arms: surgical excision by electrocautery, topical 1% cidofovir-gel (5 days per week, maximum 6 weeks) and electrocautery-cidofovir treatment with 1% cidofovir-gel applied within 1 month of surgical treatment (5 days per week for 2 weeks).


METHODS
Rate of wart clearance and time and rate of relapses within a 6-month follow-up period.


RESULTS
Complete response was achieved in 93.1% of 29 patients treated by ST, 76.2% of 26 treated by CT and in 100% of 19 patients treated by SCT (P = 0.0033). The relapse rate in 49 patients followed-up was 73.68% in ST, 35.29% in CT and 27.27% in SCT patients (P = 0.018). Median time to relapses in ST patients was 66 days (Kaplan-Meyer, P = 0.0012). Human papillomavirus DNA was cleared in 52.63% of 19 patients evaluated. The rate of clearance of high risk and low risk genotypes was 0% and 57.14% 25% and 50% 100% and 71.42% in ST, CT and SCT patients, respectively.


CONCLUSIONS
A combination of surgical and medical treatment was most effective in clearing lesions completely and in reducing the relapse rate. Human papillomavirus DNA clearance can be attributed to the antiviral effect of cidofovir and could explain the low relapse rate observed. Larger studies are required to determine the most appropriate medical treatment for viral eradication after surgery.
Orlando
Giovanna
G
II Department Infectious Diseases, STD Service, L Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy.
Fasolo
Maria Michela
MM
Beretta
Rosangela
R
Merli
Stefania
S
Cargnel
Antonietta
A
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D003131:Combined Modality Therapy; D003218:Condylomata Acuminata / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D004564:Electrocoagulation; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use*; D011446:Prospective Studies
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir