Universität zu Köln

Kreuter, Alexander, Siorokos, Christos, Oellig, Frank, Silling, Steffi, Pfister, Herbert and Wieland, Ulrike (2016). High-grade Dysplasia in Anogenital Warts of HIV-Positive Men. JAMA Dermatol., 152 (11). S. 1225 - 1231. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-6084

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Abstract

IMPORTANCE Human papillomavirus (HPV)-induced anogenital lesions are very frequent in men who have sex with men (MSM) who are HIV-positive (HIV+). Anogenital warts (AGWs) are considered benign lesions caused by low-risk HPV-types, whereas anogenital dysplasias are potential cancer precursors associated with high-risk HPV-types. Both types of lesions can usually be distinguished clinically. OBJECTIVE To describe a case series of HIV+ MSM with typical AGW that harbored different grades of dysplasia. DESIGN, SETTING, AND PARTICIPANTS For this retrospective virological analysis, we recruited 25 HIV+ MSM with AGWs (n = 38) harboring areas of dysplasia and 22 patients who were HIV-negative (HIV-) with AGWs seen between February 2013 and March 2015 at a tertiary dermatological referral center for anal cancer screening. Dysplasia-containing AGW tissue of HIV+ MSM were compared with randomly selected AGWs of patients who were HIV-. MAIN OUTCOMES AND MEASURES Histopathological analysis, immunohistochemical staining for p16(INK4a) and Ki67, HPV-typing, and viral load determination in AGWs of HIV+ compared with patients who were HIV-. RESULTS Overall, 25 HIV+ MSM with AGWs (mean [SD] age, 47.3 [11.1] years) harboring areas of dysplasia and 22 patients who were HIV- (5 women, 17 men; mean [SD] age, 35.5 [12.8] years) with AGWs were included in this study. The 38 dysplasia-containing AGWs of HIV+ MSM harbored low-grade dysplasia in 6 cases (16%), high-grade dysplasia in 31 cases (81%), and areas of invasive anal carcinoma in 1 (3%) case. With the exception of 1 biopsy, all low-grade lesions were p16(INK4a)-negative, whereas 25 of 31 (81%) AGWs with high-grade lesions or an anal carcinoma were p16(INK4a)-positive. Only low-risk HPV-types were present in 11 samples (29%; 2 low-grade lesions and 9 high-grade lesions), low-risk and high-risk types were found in 19 samples (50%; 1 low-grade lesion and 18 high-grade lesions), and only high-risk HPV-types were present in 8 samples (21%; 3 low-grade lesions, 4 high-grade lesion, and 1 cancer-containing lesion). High low-risk HPV DNA loads were found in low-grade and high-grade lesions, while high high-risk HPV DNA loads were only found in AGWs harboring high-grade lesions. The 22 AGWs of patients who were HIV-showed no signs of dysplasia, and p16(INK4a)-staining was always negative. All of these samples carried low-risk HPV types, and in 2 cases high-risk HPV-types were detected additionally. CONCLUSIONS AND RELEVANCE In contrast to immunocompetent patients, AGWs of HIV+ MSM may harbor high-grade dysplasia or even invasive squamous cell carcinoma. A substantial proportion of these lesions may only contain low-risk HPV-types. Anogenital warts in patients who are HIV+ should be evaluated histopathologically to exclude cancer precursors.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kreuter, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Siorokos, Christos UNSPECIFIED UNSPECIFIED UNSPECIFIED Oellig, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Silling, Steffi UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Herbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Wieland, Ulrike UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-256864
DOI:	10.1001/jamadermatol.2016.2503
Journal or Publication Title:	JAMA Dermatol.
Volume:	152
Number:	11
Page Range:	S. 1225 - 1231
Date:	2016
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2168-6084
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANAL INTRAEPITHELIAL NEOPLASIA; LESIONS; CARCINOMA Multiple languages Dermatology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25686