title: Preoperative immune status determines anal condyloma recurrence after surgical excision.
abstract: OBJECTIVE
  Immunosuppression is an important risk factor for anal condyloma progression; however, its effects on postoperative outcomes remain unclear. In the present study, we investigated risk factors and recurrence rates in immunocompromised patients requiring surgery for medically intractable anal condyloma.
  
  
  METHODS
  A retrospective review was performed on 63 consecutive patients who underwent surgical intervention for medically intractable anal condyloma at a single institution. Patient cohorts included immunosuppressed patients (e.g, HIV-seropositive, leukemia, idiopathic lymphopenic syndrome, or transplant patients; n = 45) and immunocompetent patients (n = 18). Recurrence rates and time to recurrence after surgery were determined for both groups. Preoperative CD4 count and viral load within the HIV subpopulation were also determined. The majority of the patients were male (90 percent), with a median age of 36 years.
  
  
  RESULTS
  Anal condyloma recurred in 66 percent of the immunosuppressed patients compared with 27 percent of the immunocompetent group. Recurrence time expressed in months was shorter in immunosuppressed patients than in immunocompetent patients (6.8 +/- 1.5 vs. 15 +/- 5.7 months; P< 0.05). In the subpopulation of HIV-seropositive patients, no association was found between recurrence rates and viral loads; however, CD4 counts were significantly lower in those who had recurrence than in those who did not (226 +/- 31.7 vs. 401 +/- 51.2 cells/microl; P< 0.05).
  
  
  CONCLUSIONS
  After surgery, anal condyloma in immunosuppressed patients recurs significantly more often and within a shorter period of time than in patients with a competent immune system. Additionally, in HIV-seropositive patients, CD4 counts should be maximized to prevent early recurrence of anal condyloma.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: de la Fuente
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Ludwig
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D000293:Adolescent; D000328:Adult; D001004:Anus Diseases / Q000150:complications / Q000276:immunology* / Q000601:surgery*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003218:Condylomata Acuminata / Q000150:complications / Q000276:immunology* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D016867:Immunocompromised Host / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load