title: Acquired epidermodysplasia verruciformis due to multiple and unusual HPV infection among vertically-infected, HIV-positive adolescents in Zimbabwe.
abstract: BACKGROUND
  We have previously described the presentation of epidermodysplasia verruciformis (EV)-like eruptions in almost a quarter of hospitalized adolescents with vertically-acquired human immunodeficiency virus (HIV) infection in Harare, Zimbabwe, a region with a high prevalence of HIV infection.
  
  
  METHODS
  We performed a clinical case note review and skin biopsy from affected sites in 4 HIV-infected adolescents with EV-like lesions in Harare. Biopsies were processed for histology and for human papillomavirus (HPV) typing.
  
  
  RESULTS
  All patients had long-standing skin lesions that pre-dated the diagnosis of HIV by several years. The histology of skin biopsies from all patients was consistent with EV. In each biopsy, EV-associated β-HPV type 5 was identified (additionally, type 19 was found in 1 biopsy). Cutaneous wart-associated HPV types 1 and 2 were detected in all biopsies, together with genital lesion-associated HPV types 6, 16, and 52, (as well as ≥3 other genital lesion-associated HPV types). Despite immune reconstitution with combination antiretroviral therapy (cART), there was no improvement in EV-like lesions in any patient.
  
  
  CONCLUSIONS
  EV is a disfiguring and potentially stigmatizing condition among this patient group and is difficult to treat; cART appears to have no impact on the progression of skin disease. Among adolescents with longstanding HIV-induced immunosuppression and with high levels of sun exposure, close dermatological surveillance for potential skin malignancy is required.
authors.affiliation: Biomedical Research and Training Institute, University of Zimbabwe, Harare, Zimbabwe. saralowe@fastmail.fm
authors.forename: S M
authors.initials: SM
authors.lastname: Lowe
authors.forename: L
authors.initials: L
authors.lastname: Katsidzira
authors.forename: R
authors.initials: R
authors.lastname: Meys
authors.forename: J C
authors.initials: JC
authors.lastname: Sterling
authors.forename: M
authors.initials: M
authors.lastname: de Koning
authors.forename: W
authors.initials: W
authors.lastname: Quint
authors.forename: K
authors.initials: K
authors.lastname: Nathoo
authors.forename: S
authors.initials: S
authors.lastname: Munyati
authors.forename: C E
authors.initials: CE
authors.lastname: Ndhlovu
authors.forename: J R
authors.initials: JR
authors.lastname: Salisbury
authors.forename: C B
authors.initials: CB
authors.lastname: Bunker
authors.forename: E L
authors.initials: EL
authors.lastname: Corbett
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
authors.forename: R A
authors.initials: RA
authors.lastname: Ferrand
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D016172:DNA Fingerprinting; D004819:Epidermodysplasia Verruciformis; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D006651:Histocytochemistry; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008853:Microscopy; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D012867:Skin / Q000473:pathology / Q000821:virology; D015030:Zimbabwe