HPV genotype is a prognosticator for recurrence of respiratory papillomatosis in children

Abstract

Recurrent respiratory papillomatosis (RRP) is a rare condition characterised by exophytic proliferative lesions (papillomas) in the airway, mainly at the larynx, caused by human papillomavirus (HPV) infection. The symptoms may vary from hoarseness to respiratory distress, and the disease may present a devastating impact on the quality of life of affected patients due to the high number of recurrences, often requiring multiple surgeries, or even tracheostomy. 1 The prevalence of RRP is in decline with the introduction of the HPV vaccine; however, RRP still is the most common benign laryngeal tumour in children. 1

HPV-Associated Benign Squamous Cell Papillomas in the Upper Aero-Digestive Tract and Their Malignant Potential

“…The authors identified three different HPV6 subtypes: HPV6a, HPV6b, and HPV6vc, with the latter being the most common. HPV6 subtype or viral load/HPV mRNA expression levels were not associated with the clinical parameters (age, sex, tumor location, Derkay score) [ 73 ], as also recently confirmed by two other studies [ 10 , 74 ]. Sichero L et al (2021) found no association between any particular HPV11 variant and clinic-pathological features among the 79 RRP patients studied [ 74 ].…”

“…The outcomes of RRP are variable among individual patients, and several studies have focused on the risk factors associated with a more aggressive outcome. Most studies agree that a younger age at onset of JO-RRP is an important independent predictor of disease severity [ 10 , 15 , 16 , 64 ]. Age at onset was the only significant risk factor for aggressive disease in JO-RRP, whereas in adults, both HPV11 and observation time ≥10 years were significant [ 64 ].…”

“…Patients with JO-RRP and HPV11 tend to present an increasingly worse Derkay score at each surgery. HPV genotype among the AO-RPP patients had no impact on disease outcome [ 10 ].…”

“…The two most frequent HPV genotypes associated with SCPs are HPV6 and HPV11, but high-risk HPV16 and 18, and other mucosal alpha-HPVs, have been detected at a lower frequency [ 1 , 2 , 9 , 10 , 11 ]. Importantly, recent evidence also indicates the presence of cutaneous HPVs of the beta-and/or gamma genera in oral, oro-, and hypopharyneal papillomas, as well as anecdotally in laryngeal papillomas [ 12 , 13 ].…”

HPV Strain Predicts Severity of Juvenile-Onset Recurrent Respiratory Papillomatosis with Implications for Disease Screening

“…Numerous case studies of HPV11+ RRP patients have been reported that detail the fatal progression of the disease [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Similarly, analysis of retrospective cohorts has suggested that HPV11+ disease is associated with worse outcomes [ 19 , 20 , 21 , 22 , 23 , 24 ]. However, others have countered these findings [ 25 , 26 , 27 , 28 ] or concluded that an early age of onset, and not the HPV strain, predicts disease severity [ 29 , 30 , 31 , 32 ].…”