Epidermodysplasia Verruciformis in Human Immunodeficiency Virus–Infected Patients

Abstract

Background: Skin eruptions resembling epidermodysplasia verruciformis (EV) are rarely observed in immunocompromised patients. We focused on the epidemiologic, clinical, virologic, and immunologic features of EV in human immunodeficiency virus (HIV)-positive patients. Observations: We studied 11 HIV-positive patients (6 men and 5 women) with clinical and histological features of EV observed at our department. The median age at HIV diagnosis was 27 years. At the onset of eruption, the median age was 40 years and the median CD4 T-cell count was 170/µL. Clinical presentation included flat warts (n=11), pityriasis versicolor-like macules (n=5), and lichenoid papules (n = 3) on sun-exposed skin. Detection and typing of cutaneous human papillomavirus (HPV) were carried out in 8 cases and always revealed ␤-HPV infection, including oncogenic HPV-5 or 8 (n =6). Mu-cosal HPV-related diseases were present in 7 cases. Histories of skin cancer and lymphoproliferative disorder were recorded in 3 and 4 patients, respectively, including 2 fatal cases. Skin eruption was never improved by highly active antiretroviral therapy (HAART). In 2 cases, EV was associated with an immune reconstitution syndrome. The present series is the largest with a complete characterization. A review of similar cases was carried out. Conclusion: Despite effective HAART, HIV-infected patients with EV require a prolonged and careful follow-up to detect mucosal HPV-related diseases, lymphoproliferative disorders, and skin cancers.

Cutaneous Manifestations of Human Immunodeficiency Virus: a Clinical Update

“…Three out of the five were found to carry high-risk HPV types [23]. Similar to previous reports, immunologic recovery and viral load suppression upon ART did not lead to improvement of the cutaneous lesions [24]. Long-term follow-up is necessary since the risk of cutaneous malignancy is unknown.…”

Acquired Epidermodysplasia Verruciformis Due to Multiple and Unusual HPV Infection Among Vertically-Infected, HIV-Positive Adolescents in Zimbabwe

“…HPV 1 and 2, classically associated with plantar warts, were also isolated in skin biopsies from our patients, together with HPV 5, commonly found in patients with congenital EV [18]. HPV 3, a cutaneous wart–associated HPV type, has previously been identified in EV lesions from 1 HIV-infected individual; by contrast, HPV 1 or 2 have not been described [9]. …”

Warty papules in a child with human immunodeficiency virus

“…There appears to be no benefit derived from antiretroviral therapy. In fact, several cases have reported onset or worsening of the existing eruption after initiation of antiretroviral therapy . Imiquimod, topical retinoids, interferon and cimetidine have been trialled, with limited success.…”

“…EV is a rare autosomal recessive genodermatosis, which was first described by Lewandowsky and Lutz in 1922. 1 The condition confers an extreme susceptibility to certain human papillomaviruses (HPV 5,8,9,12,14,15,17,(19)(20)(21)(22)(23)(24)(25), which are nonpathogenic in the normal population. Mutations in the EVER1 and EVER2 genes on chromosome 17q25 have been identified in around 75% of cases.…”