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.
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.
Sanclemente
G
G
Dermatology Section, Department of Internal Medicine, University of Antioquia, Medellín, Colombia. gsanclemente@une.net.co
Herrera
S
S
Tyring
S K
SK
Rady
P L
PL
Zuleta
J-J
JJ
Correa
L-A
LA
He
Q
Q
Wolff
J-C
JC
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000821:virology; D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D000287:Administration, Topical; D000328:Adult; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D001004:Anus Diseases / Q000188:drug therapy* / Q000821:virology; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000821:virology; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000821:virology; D003218:Condylomata Acuminata / Q000188:drug therapy* / Q000821:virology; D005832:Genital Diseases, Male / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000821:virology; D016133:Polymerase Chain Reaction; D016896:Treatment Outcome; D019562:Viral Load
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000077271:Imiquimod