Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution-associated disease?

Abstract

Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.

Manejo Quirúrgico de Múltiples Condilomas de la Mucosa Oral en Paciente Bajo Terapia Antirretroviral de Gran Actividad

“…Existen estudios que han propuesto que sería una manifestación de SRI (Meys et al, 2010), mientras que otros sostienen que no existiría un efecto demostrable en la respuesta inmune local en este tipo de patologías (Lilly et al, 2005).…”

Characterization of the OSSN Microbiome in HIV-1 Infected Patients

“…Though our patient cohort was under Antiretroviral Therapy (ART) started at different time points, their effects with regards to these infectious agents that also cause immunosupression and some cancers has not been evaluated. It is possible that before ART era AIDS patients died before the appearance of HPV and other HIV associated lesions, and that the prolongation of life now allows the development of these benign and neoplastic lesions (Meys, Gotch, & Bunker, 2010). There are studies that show that the success of ARTs lowering HIV-1 viral load leads to increased opportunistic infections, some of which are drug resistant (Palefsky, 2009;Croft, Sundar, & Fairlamb, 2006;Legros, Evans, Maiso, Enyaru, & Mbulamberi, 1999).…”

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

“…There is an increasing incidence of anal cancer in HIV-positive patients, in particular, men who have sex with men [30,31]. In these groups, the risk of anal cancer may be up to 40-times greater than the background population [32], with anal cancer becoming the fourth most common cancer in patients with HIV [33].…”