Anogenital Warts Carry Higher Risk of High-Grade Dysplasia in HIV+ Men
Human papilloma virus (HPV)-induced anogenital warts (AGWs) and anogenital dysplasias are common in HIV-positive (HIV+) men who have sex with men (MSM). Typically, AGWs are considered benign lesions caused by low-risk HPV-types.
A recent study sought to answer the question of whether anogenital lesions of HIV-positive men that clinically appear as benign warts contain areas of dysplasia, and if so, to determine the virological characteristics of those lesions. Previous studies have indicated that anogenital lesions of patients who are HIV+ may morphologically appear benign but may actually harbor focal areas of high-grade dysplasia. The study looked at a total of 73 HIV+ MSM who participated in an anal cancer screening program. Thirty-six (49%) of these HIV+ MSM had AGWs at first presentation. For comparison, randomly selected AGWs of 22 otherwise healthy patients who are HIV-negative (HIV−) seen in the same time period were analyzed. The results showed that in this case series, a high proportion of anogenital warts in the HIV+ group contained areas of high-grade and low-grade dysplasia or in a few cases, invasive cancer. In contrast, dysplasia was absent in all lesions of immunocompetent control patients.
The authors conclude that though this was a small retrospective study, the findings are consistent with previous data. This study demonstrates that, in contrast to patients who are HIV−, AGWs of HIV+ MSM may harbor high-grade dysplasia or even cancer, although the clinical appearance was similar to classical benign AGWs. The authors suggest that all HPV-induced anogenital lesions of high-risk patients such as HIV+ MSM should be evaluated histopathologically and HPV genotyping should be considered if areas of dysplasia are detected. They offer detailed recommendations for diagnosis and treatment of AGWs in HIV-positive men.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: January 9, 2017
Source: JAMA Network
Adapted from the original article.