[Effects of imiquimod on latent human papillomavirus anal infection in HIV-infected patients].
BACKGROUND
High risk human papillomaviruses (HPV) have emerged as risk factors for anal carcinoma particularly in HIV-infected patients who demonstrate a high rate of anal HPV infection. Considering the relationship between the presence of anal infection and the development of neoplastic lesions, we wished to assess the capacity of imiquimod to eradicate latent HPV infection in HIV-infected patients.


METHODS
We conducted a prospective, randomized, double-blind and vehicle controlled study. Two consecutive anal swabs were taken at 2 month intervals and only patients with two consecutive tests positive for the detection of HPV-DNA (Hybrid Capture II) were included. Patients with persistent latent HPV infection were divided into 2 groups who applied imiquimod versus vehicle during 6 weeks. HPV-DNA presence was then investigated 2 and 4 months following the onset of treatment.


RESULTS
Among the 80 HIV-infected patients, 26 (32.5 p. 100) had 2 positive consecutive assays, and 19 patients were included in the study. After randomization, 9 patients received imiquimod and 10 vehicle. There was no significant difference between treatment groups according to the following criteria: gender, route of HIV transmission, CDC stage, prior medical history of sexually transmitted diseases or anogenital warts. 33.3 p. 100 (3/9) of patients treated with imiquimod were negative at M2, whereas 100 p. 100 (10/10) vehicle treated-patients remained positive (p=0.08). Similar results were observed at the M4 visit.


CONCLUSIONS
Our study confirmed the increased prevalence of latent HPV-DNA infection in HIV-infected patients. In spite of the low number of treated patients, we did not observe a statistically significant decrease in HPV-DNA in anal swabs from imiquimod-treated patients as compared to placebo-treated patients.
Pelletier
F
F
Service de Dermatologie, CHU Saint-Jacques, Besançon.
Drobacheff-Thiebaut
C
C
Aubin
F
F
Venier
A-G
AG
Mougin
C
C
Laurent
R
R
D000276:Adjuvants, Immunologic / Q000494:pharmacology* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000634:Aminoquinolines / Q000494:pharmacology* / Q000627:therapeutic use; D001004:Anus Diseases / Q000188:drug therapy / Q000821:virology; D001005:Anus Neoplasms / Q000517:prevention & control / Q000821:virology; D002277:Carcinoma / Q000517:prevention & control / Q000821:virology; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod