title: Imiquimod leads to a decrease of human papillomavirus DNA and to a sustained clearance of anal intraepithelial neoplasia in HIV-infected men.
abstract: Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-associated precursor lesion of anal carcinoma, is highly prevalent in HIV-infected men having sex with men (MSM). This prospective follow-up study evaluated the long-term results of imiquimod treatment of AIN in 19 HIV-infected MSM. Standardized follow-up examinations included high-resolution anoscopy, anal cytology/histology, HPV typing, and DNA load determination for HPV types 16, 18, 31, and 33. Mean follow-up time was 30.3 months. A total of 74% (14/19) of the patients remained free of AIN at the previously treated site. Five patients (26%) had recurrent high-grade AIN after a mean time of 24.6 months. At the end of follow-up, the numbers of HPV types as well as high-risk HPV-DNA loads were significantly lower than before therapy. During follow-up, 58% of all patients (11/19) developed new anal cytological abnormalities in previously normal, untreated anal regions. 55% of these new AIN lesions were high-grade lesions and most of them were located intra-anally and associated with high-risk HPV types not detectable before therapy. These results demonstrate that imiquimod leads to a high rate of long-term clearance of AIN in HIV-positive men together with a prolonged decrease of high-risk HPV-DNA load. However, new AIN lesions associated with previously undetected HPV types frequently occur in untreated areas.
authors.affiliation: 1Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kreuter
authors.forename: Anja
authors.initials: A
authors.lastname: Potthoff
authors.forename: Norbert H
authors.initials: NH
authors.lastname: Brockmeyer
authors.forename: Thilo
authors.initials: T
authors.lastname: Gambichler
authors.forename: Markus
authors.initials: M
authors.lastname: Stücker
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
authors.forename: Jochen
authors.initials: J
authors.lastname: Swoboda
authors.forename: Herbert
authors.initials: H
authors.lastname: Pfister
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wieland
mesh_terms: D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D002278:Carcinoma in Situ / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000187:drug effects*; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D052162:Human papillomavirus 16 / Q000235:genetics; D052161:Human papillomavirus 18 / Q000235:genetics; D006801:Humans; D000077271:Imiquimod; D008137:Longitudinal Studies; D008297:Male; D027383:Papillomaviridae / Q000235:genetics*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D004279:DNA, Viral; D000077271:Imiquimod