Description:
Human papilloma virus (HPV)-related anogenital neoplasms are being reported with increasing frequency in HIV-infected people in the United States and Europe. Klein et al. found that HIV-positive women have a higher rate of squamous intraepithelial lesions (SIL) on PAP smear than HIV-negative women. SIL was detected on PAP smear in 28/111 (25%) HIV-positive and 11/107 (10%) HIV-negative women. Vernon et al. reported that asymptomatic HIV-positive women have a significantly higher risk of cervical intraepithelial neoplasias (CIN) with HPV, than HIV-negative women do. It was discovered that HIV with associated HPV co-localized in CIN lesions occurred frequently and that co-localization was independent of both clinical status and CD4 counts. Regevik et al. found that HIV-infected women with CD4 counts below 500/mm3 and with evidence of HPV infection may be at higher risk for developing neoplastic changes in the cervix.
Sites of Infection:
HPV-related anogenital abnormalities can manifest as a field disease, potentially involving the cervix, vagina, vulva, perianal area and anal canal, as well as the penis and urethra. Bouchaud et al. reports that HPV has also been found in the esophagus.
Diagnosis:
Treatments:
A clinical trial of Imiquimod, a heterocyclic amine in a topical form which stimulates the production of interferon, has been shown to be effective in treating genital and perianal warts.
REFERENCES:
Regevik N et al. Cervical human papillomavirus (HPV) in correlation with immune status and papanicolaou smear abnormalities. Abstract TuB O528, VII lntl Conf AIDS, Amsterdm, 1992.
Vernon S et al. Localization of HIV-1 to human papillomavirus associated cervical lesions. Lancet 344(8927): 54, 1994.
OTHER REPORTS
Bouchaud O et al. Human papillomavirus in the esophagus in HIV patients. Abstract PBO171, X Intl Conf AIDS, Yokohma, 1994.
Brown D et al. Detection of multiple human papillomavirus types in condylomata acuminate from immunosuppressed patients. J Infect Dis 170(4): 759-765, 1994.
Byrne M et al. The common occurrence of human papillomavirus infection and intraepithelial neoplasia in women infected by HIV. AIDS, 3: 379-82, 1989.
Krown S. Treatment of AIDS-associated malignancy. Cancer Detect & Prev 14(3): 405-9, 1990.
Lowry D et al. Genital human papillomavirus infection. PNAS 91: 2436-2440, 1994.
Mandelblatt JS et al. Association between HIV infection and cervical neoplasia: implications for clinical care of women at risk for both conditions. AIDS 6:173-8, 1992.
Schrager et al. Cervical and vaginal squamous cell abnormalities in women infected with human immunodeficiency virus. J AIDS 2: 570-5, 1989.
Klein RS et al. A prospective study of genital neoplasia and human papillomavirus (HPV) in HIV infected women. Abstract TuB O527, VIII Intl Conf AIDS, Amsterdam, 1992.
Baggish M. Carbondioxide laser treatment for condylomata acuminate
venereal infections. Obstetrics and Gynecology, 55(6): 711-714, 1980.
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