RESUMEN
OBJECTIVE: To evaluate the efficacy of 5% imiquimod in HIV-positive male patients with anogenital warts or anal intraepithelial neoplasia (AIN), and to elucidate whether human papillomavirus (HPV) type and viral load were important for clinical outcome and recurrences. METHODS: Thirty-seven patients with histologically proven anogenital warts or AIN were enrolled. Topical 5% imiquimod was applied three times per week for more than 8 h overnight for 16 weeks, although patients were allowed to continue therapy for 4 more weeks if they did not have complete clearance of lesions. RESULTS: Mean age was 34 years. The perianal area was the main lesion location. Thirty-three patients had CD4 counts of < 500 cells/mm(3). Eighteen patients had a histopathological diagnosis of AIN-1. Main HPV types detected corresponded to low-risk HPV types. At 20 weeks of therapy, 46% patients achieved total clearance whereas 14 patients had > 50% clearance. Recurrence was observed in 5 of 17 patients who cleared. Clearance was not influenced by patients' CD4 counts, wart location, HIV viral load or HPV viral load. CONCLUSIONS: The assumption that visible perianal warts are benign lesions in HIV-positive patients has to be reevaluated since an important number of such lesions could correspond to low-grade anal disease, which in turn could progress to high-grade anal disease or cancer. In addition, our results in this preliminary study indicate that imiquimod appears to be effective in treating AIN in HIV-positive patients. Further studies are needed to document its utility to prevent high-grade dysplasia and/or anal cancer.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adyuvantes Inmunológicos/uso terapéutico , Aminoquinolinas/uso terapéutico , Enfermedades del Ano/tratamiento farmacológico , Neoplasias del Ano/tratamiento farmacológico , Condiloma Acuminado/tratamiento farmacológico , Enfermedades de los Genitales Masculinos/tratamiento farmacológico , Infecciones por Papillomavirus/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adyuvantes Inmunológicos/administración & dosificación , Administración Tópica , Adulto , Aminoquinolinas/administración & dosificación , Enfermedades del Ano/virología , Neoplasias del Ano/virología , Carcinoma in Situ/tratamiento farmacológico , Carcinoma in Situ/virología , Condiloma Acuminado/virología , Enfermedades de los Genitales Masculinos/virología , Humanos , Imiquimod , Masculino , Persona de Mediana Edad , Papillomaviridae/clasificación , Infecciones por Papillomavirus/virología , Reacción en Cadena de la Polimerasa , Resultado del Tratamiento , Carga ViralAsunto(s)
Epidermodisplasia Verruciforme/complicaciones , Neoplasias Cutáneas/complicaciones , Adolescente , Adulto , Alphapapillomavirus/patogenicidad , Brasil , Carcinoma de Células Escamosas/patología , Epidermodisplasia Verruciforme/inmunología , Femenino , Humanos , Inmunidad Celular/inmunología , Queratosis/patología , Masculino , Infecciones por Papillomavirus/patologíaRESUMEN
Infection with high-risk human papillomavirus (HPV) is considered a "necessary cause" for cervical cancer (CC); however, only some HPV-infected women develop CC. We report on the differential risk contribution of sexual behavior and cigarette smoking to cervical neoplasia in the US and Venezuela. A total of 142 patients and 158 matched-controls were recruited from both countries using the same recruitment protocol, the same pathologists for case verification, and the same experimental procedures for analysis. HPV infection was significantly associated with CC for both populations as expected, but the Venezuelan controls were twice as likely to be infected with HPV as the US controls. Having >2 lifetime sexual partners (OR = 4.7, 95% CI = 1.7-13.1) and initiation of sexual activities before the age of 18 (OR = 4.7, 95% CI = 1.6-13.7) were significant risk factors in a multivariate model for CC in Venezuela. In contrast, current cigarette smoking was a significant risk factor only in the US (OR = 3.6, 95% CI = 1.7-7.7). The observed differences in risk factors support the need for additional studies in different geographic regions and the information can be used to develop country-specific CC prevention programs.
Asunto(s)
Conducta Sexual , Fumar/efectos adversos , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/etiología , Adolescente , Adulto , Factores de Edad , Estudios de Casos y Controles , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiología , Neoplasias del Cuello Uterino/etnología , Venezuela/epidemiologíaRESUMEN
Thirteen patients with epidermodysplasia verruciformis (EV) were studied over a period of 7 years. EV is a rare genodermatosis characterized by a generalized infection with a specific group of human papilloma virus (HPV) and a propensity for developing skin malignant tumours in 30%-50% of patients. The diagnosis of EV was confirmed by histopathological and immunohistochemical findings. Three of our patients had the benign form of EV, which is characterized by monomorphous lesions and no malignant changes, whereas 10 had the malignant form, which is characterized by polymorphic lesions and development of cutaneous malignant tumours. All EV patients with the malignant form developed multiple skin tumours (77%). They started to appear at age 20, predominantly on the forehead (50%). Most were squamous cell carcinoma, extremely aggressive and invasive, which provoked metastasis and death in two patients.
Asunto(s)
Transformación Celular Neoplásica/patología , Epidermodisplasia Verruciforme/patología , Papillomaviridae/aislamiento & purificación , Lesiones Precancerosas/patología , Adolescente , Adulto , Distribución por Edad , Biopsia con Aguja , ADN Viral/análisis , Progresión de la Enfermedad , Epidermodisplasia Verruciforme/epidemiología , Epidermodisplasia Verruciforme/virología , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Incidencia , Masculino , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores de TiempoRESUMEN
Because of its ability to produce two clinically distinct disease entities (chickenpox and shingles), varicella zoster virus (VZV) is an unusual etiologic agent. Although in the past viral exanthems were mostly only of academic interest to the practitioner, the development of antiviral agents and the newly approved varicella (OKA) vaccine have increased the clinical significance. Also, with the increasing seroprevalence of HIV infection, more patients will be stricken with zoster (at a younger age) and disseminated varicella. In this review, the history, incidence, pathogenesis, clinical manifestations, and treatment options (of VZV infection and postherpetic neuralgia) will be discussed.