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:
CreatorsEmailORCIDORCID Put Code
Kreuter, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Siorokos, ChristosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oellig, FrankUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Silling, SteffiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfister, HerbertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wieland, UlrikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
ANAL INTRAEPITHELIAL NEOPLASIA; LESIONS; CARCINOMAMultiple languages
DermatologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/25686

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