Comparison of clinical, histological, and virological symptoms of HPV in HIV-1 infected men and immunocompetent subjects

Abstract

Objective:We assessed the clinical, histological, and virological features of anogenital human papillomavirus (HPV) infection, according to their immune status in HIV-1 infected men, referred for an anogenital examination or treatment, in comparison with immunocompetent patients. Methods: The study population comprised 33 HIV-1 infected heterosexual or homosexual men and 38 HIV negative men seen in a screening and treatment centre for anogenital HPV infections. All patients were examined with a colposcope. Biopsies were carried out on all subjects with anogenital lesions for histological studies and HPV detection by Southern blot. Results: The HIV infected patients had a balanopreputial HPV infection in 70%, anal in 30%, and urethral in 37%, while HIV negative patients had balanopreputial lesion in 72%, anal in 26%, and urethral in 16%. DiVuse anogenital lesions were present in 33% of the HIV infected cases and in 10.5% of HIV negative cases (p<0.02). Among the HIV infected patients, the genital HPV lesions were condylomatous in 67.5% of the cases and dysplastic in 57%. HIV negative patients had condylomatous lesions in 86% of the cases and dysplasic in 14%. The condylomatous lesions of HIV infected patients had a low grade malignant histological aspect in 36% of the cases and high grade histological criteria were found in 22% of the dysplasias. Oncogenic HPVs were detected more frequently in HIV infected patients (35% v 12%) and more than one HPV type was found in 21.5% of cases. Neither the anogenital diVusion of the HPV lesions nor their morphological, histological, and virological features diVered significantly in patient with CD4 cell counts > or < 200 × 10 6 /l. In contrast, patients with CD4 cell counts < 50 × 10 6 /l had a higher risk of several types of HPVs and of developing a diVuse anogenital infection. Conclusion: HIV-1 infected patients had an increased frequency of high grade anogenital dysplastic lesions and a higher frequency of HPV infection with multiple and diVuse sites of involvement. These characteristics of HPV infection were independent of the patients' immune status up to CD4 cell counts > 50 × 10 6 /l but showed an increased risk when the CD4 cell count was < 50 × 10 6 /l. The higher frequency of diVuse anogenital infections among HIV infected men calls for rapid treatment, laser or surgery, given the association of histological features of intraepithelial neoplasia and the presence of multiple HPV infection sites which may be the consequence of immune disturbances, most of which are transmissible potentially oncogenic HPVs. (Sex Transm Inf 1998;74:32-34)

Cell-Mediated Immune Response to Human Papillomavirus Infection

“…Such individuals show increased prevalence of anogenital HPV infection (31, 32, 60, 105-107) as well as longer periods of HPV persistence (31,40,46,90,136). In addition, infection with multiple HPV types and with oncogenic types are more common (9,31,46,78,90,107,136). Associations between markers of HIV disease status (e.g., viral load and CD4 lymphocyte count) and HPV infection have been inconsistent.…”

“…These differences may have been due to specific population characteristics, such as young age, or early stages of HIV infection (93). The risk of abnormal cervical or anal cytology as well as of HPVrelated anogenital disease (cervical SIL or anal intraepithelial neoplasia) is also increased in HIV-infected individuals (9,33,46,60,73,78,93,105,106,117,147). While, as mentioned above, most studies have suggested that the association between HIV infection and increased prevalence of HPV infection and disease is related to the immunosuppression seen in HIV infection, there is also some evidence that mechanisms other than immunosuppression, such as direct molecular interactions between HIV and HPV viral genes, may influence the natural history of HPV (8,43,93,146).…”

Clinico-Epidemiological Profile of Viral Sexually Transmitted Infections in Seropositive Patients Attending a Tertiary Care Hospital in North India

“…The correlation of human papilloma virus (HPV) and HIV infection has been reviewed extensively, and numerous case reports exist in the literature depicting giant form of condyloma acuminata, perianal involvement, widespread lesions, and severe painful ulcerations to be more frequent in the seropositive group. [35][36][37][38] In our study, one-fourth of patients with genital warts were resistant to conventional treatment. This is similar to a study by De Panfilis et al where the warts in seropositive patients were persistent (treatment resistant) and had more frequent relapses.…”

Avaliação dos resultados do tratamento de 14 doentes de carcinoma espinocelular anal

“…8,9,10 Os HPVs dos tipos 5,8,16,18, 31 e 45 são os mais encontrados nas lesões neoplásicas e são chamados de alto risco. 11,12 A ligação de proteína E6 dos HPVs de alto risco à proteína P53 causa rápida degradação dessa última, levando à perturbação do controle do crescimento celular. 13 Acredita-se que o potencial oncogênico desses vírus ocorra, em parte, devido a essa interação.…”