Efficacy of topical imiquimod in HIV-positive patients with recurrent anal condylomata acuminata

Abstract

INTRODUCTION: Imiquimod is a topical chemotherapic and immunostimulant agent with antitumoral and antiviral activities, used for anal condylomata acuminata treatment, mainly in recurrences. OBJECTIVE: Evaluate the imiquimod efficiency in chronic and recurrent anal condylomata acuminata in HIV-infected persons. METHOD: A prospective study that analyzed 61 patients with recurrent anal condylomata treated with topic 5% imiquimod, for at least 8 weeks. These patients had already been submitted to other topical and surgical treatments for anal warts. We evaluated the efficiency of this agent, through wart remission, with clinical examination and high-resolution anoscopy, CD4+ T lymphocyte count and side effects. The patients were 55 males and 6 females, from 22 to 63 years old. RESULTS: Remission was seen in 90%, being 46% complete remission and 44% partial remission. Other 10% did not respond to the treatment with imiquimod within the 16th week. Recurrences were observed in 11% of patients in 24-week follow-up. Statistics showed no differences in CD4+ T cell scores when groups with and without complete remission were compared. Adverse effects were reported by 45% of patients. They were mild to moderate burning (25%), intense burning (7%), ulcerative dermatitis (8%) and systemic symptoms (5%). CONCLUSION: Imiquimod was effective in controlling recurrent anal condylomata acuminata in HIV-positive patients, regardless of CD4+ T cell count.<br>INTRODUÇÃO: O imiquimode é agente tópico quimioterápico e imunoestimulante, com atividades antitumoral e antiviral, usado para tratamento dos condilomas acuminados perianais, principalmente os recidivantes. OBJETIVO: Avaliar a eficácia do imiquimode nos condilomas acuminados perianais crônicos e multirrecidivantes dos doentes soropositivos para o vírus da imunodeficiência adquirida (HIV). CASUÍSTICA E MÉTODO: Estudo clínico prospectivo por 12 meses em que observamos o uso tópico de imiquimode creme 5%, por no mínimo 8 semanas, em 61 portadores de condilomas acuminados perianais recidivantes e de difícil controle, e que já haviam sido submetidos a vários outros tratamentos clínicos e operatórios. Avaliamos a eficácia do produto quanto sua remissão (através de exame clínico e colposcópico), nível dos linfócitos T CD4+ e efeitos adversos. Foram 55 homens e 6 mulheres com idade entre 22 e 63 anos. RESULTADOS: Obtivemos 90% de remissão, sendo 46% de resposta completa, 44% de resposta parcial e 10% sem qualquer resposta em até 16 semanas de tratamento com imiquimode. A taxa de recidiva atingiu 11% em 24 semanas de seguimento. Quanto ao nível de linfócitos T CD4+, não observamos diferença estatística entre o grupo que atingiu remissão completa e o grupo que manteve lesões. Efeitos adversos foram relatados por 45% dos doentes, sendo ardor leve a moderado (25%), ardor intenso (7%), dermatite ulcerativa (8%) e efeitos sistêmicos (5%). CONCLUSÃO: O imiquimode foi efetivo no controle dos condilomas acuminados perianais recidivantes dos doentes HIV-positivo, independente da contagem sérica dos ...

Behandlung HPV-assoziierter analer Läsionen bei HIV-positiven Patienten – chirurgische Abtragung vs. topische Therapie mit Imiquimod

“…Herrera et al konnten diesen Zusammenhang 2007 in ihrer Open-Label-Studie mit 43 Patienten nicht bestätigen [11]. Auch in einer weiteren prospektiven Studie mit 61 Patienten wurde kein Zusammenhang zwischen der CD4-Zellzahl und dem Therapieerfolg mit Imiquimod nachgewiesen werden [10]. Die Wechselwirkungen zwischen TLR-7/8-Aktivierung durch Imiquimod bei HIV + -Patienten mit und ohne antiretrovirale Therapie sind jedoch ungenügend verstanden, sodass neben der reinen CD4-Zellzahl auch andere Gründe für ein schlechteres Ansprechen dieses Patientenkollektivs denkbar sind.…”

“…Grundsätzlich stellt das Leitlinienkomitee keinen Unterschied in der Behandlung HPV-assoziierter Läsionen bei HIV-positiven und HIV-negativen Patienten fest. Umstritten ist weiterhin, ob die CD4-Zellzahlen eine Auswirkung auf das Ansprechen auf die topische Therapie mit Imiquimod haben [9,10].…”

Intra-anal use of imiquimod: what is the clinical evidence?

“…The search performed in PubMed and Scopus retrieved a total of 177 and 231 search results, respectively, among which 14 studies (three randomized controlled trials, five retrospective studies, four prospective studies, and two case reports) were identified as eligible for inclusion in this review. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] Among the included studies, two additional articles were identified through hand-searching of references. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for carrying out this systematic review.…”

HPV-associated anal lesions in HIV+ patients: long-term results regarding quality of life

“…The CECA questionnaire was developed by Badia et al in 2005 and has been translated into English, Chinese, and German [16,17]. The questions of the CECA questionnaire are similar to the DQLI (Dermatology Life Quality Index), but include also questions on morbidity related to HPV-associated anogenital lesions [18]. In our study, the CECA questionnaire was also adopted for patients with AIN, since these patients are often associated with CA.…”