Multiple preinvasive and invasive HPV-related lesions of the anogenital tract in a female patient with HIV infection

Abstract

Rationale:Patients with human immunodeficiency virus (HIV) infection have been shown to be at increased risk for high-risk human papillomavirus (HR-HPV) infection of the anogenital tract. Furthermore, in the last decades, the introduction of highly active antiretroviral therapy (HAART) has increased the longevity of these patients who now live long enough to develop HPV-related cancers; hence, the impact of HPV infection on HIV-positive patients is of increasing concern.Patient concerns:We reported the case of an HIV-positive female patient on HAART with a good virological and immunological response and with a long history of HPV-related intraepithelial and invasive lesions of the anogenital tract.Diagnoses:From 1996 to 2016, this patient was diagnosed with a high grade cervical intraepithelial neoplasia; a HR-HPV positive inguinal lymph node metastasis from clinically undetectable primary squamous cell carcinoma; a HPV-related vulvar high-grade squamous intraepithelial lesion and an invasive squamous cell carcinoma of the anus.Interventions:All the intraepithelial and invasive lesions detected were properly treated, and subsequent follow up visits with gynecologic examination, anoscopy, pap smear and anal cytology were performed.Outcomes:After a recurrence of the anal cancer and a subsequent salvage surgery with abdominoperineal resection, at the last available follow up visit no sign of disease recurrence was found.Lessons:This case stresses the importance of an accurate multidisciplinary follow-up in HIV-positive patients, including not only the routine medical, immunological, and virological evaluation, but also a periodical complete examination of the anogenital tract with cervicovaginal and anal cytology, colposcopy, high resolution anoscopy, and vulvar examination.

Extramammary Paget’s Disease of the Vulva and Concomitant Premalignant/Malignant Vulvar Lesions: A Potential Challenge in Diagnosis and Treatment

“…As shown, the association between EMPDV and vulvar HSIL (formerly known as U-VIN) is the most commonly reported in the literature. When this association occurs, a complete evaluation of the lower genital tract (with a pap smear, HPV test and colposcopy) is advisable because multiple HPV-related lesions can be present, especially in immunocompromised patients [31]. In the case of VIN, a small surgical excision is usually performed because a free margin of a few millimeters is considered to be safe; positive margins do not predict the development of invasive disease and the need to re-excide the tissue around the scar remains to be demonstrated [32].…”

Protease inhibitor effects on prevalence of bacterial vaginosis and human papillomavirus‐related lesions

“…Human immunodeficiency virus‐related immunodeficiency is known to have an unfavorable impact on the natural history of HPV and is associated with increased acquisition and persistence of HPV infection. It is also associated with an increased risk of high‐ and low‐grade intraepithelial lesions and invasive carcinoma, in addition to a higher co‐infection rate with multiple high‐risk HPV types compared with HIV‐negative individuals . Persistent detection of the HPV is associated with increased risk for cervical dysplasia and malignancy …”

Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study

“…M en who have sex with men (MSM), 1 people with HIV, 2,3 homeless people (many of whom participate in survival sex), female sex workers, 4 transgender women 5 and rape victims 6 are at high risk for human papillomavirus (HPV) infection and consequently developing cancers associated with chronic HPV infection including cervical, vaginal, 7 vulvar, 8 and anal cancers in women, cancer of the penis, 9 anal cancer 10,11 in men, and cancer of the oropharynx, 12 tongue, and tonsils in both men and women. [13][14][15] In part, this is related to increased life expectancy among people with HIV (given greater anti-retroviral treatment coverage). 16 Some countries have implemented HPV vaccination policies that include men.…”