HIGH-GRADE DYSPLASIA IN GENITAL WARTS FROM 2 PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Cancer-associated human papillomavirus (HPV) types are detected in gen ital warts removed from immunosuppressed individuals more commonly tha n from those occurring in otherwise healthy individuals. The prognosis of genital warts containing cancer-associated HPV types is not known. Because it is assumed that genital warts are benign lesions, they are usually treated by destructive therapies without prior knowledge of h istopathology. The aim of the present study was to determine whether g enital warts from individuals with or without human immunodeficiency v irus (HIV) contain high-risk HPV types or areas of dysplasia. The stud y design was a nonrandomized analysis of genital warts removed by exci sion biopsy from 15 HIV-infected patients and 15 HIV-negative patients . The tissue was analyzed for HPV DNA by hybrid capture, and microscop ic sections of each biopsy were examined for areas of dysplasia. Genit al warts from HIV-infected patients contained cancer-associated (''hig h risk'') HPV types in 9 of 15 cases, including 1 that contained only a high-risk type. High-grade dysplastic abnormalities were present in 2 of the 15 lesions from this group, both of which contained high-risk HPV types. Four genital warts removed from HIV-negative patients cont ained high-risk HPV types, but none contained dysplastic abnormalities . It is concluded that genital warts from HIV-infected patients often contain high-risk HPV types. Such lesions may exhibit dysplastic chang es. The frequency of dysplastic changes in genital warts from HIV-infe cted patients is not known. Biopsy of genital warts may be indicated p rior to additional therapy in HIV-infected patients, and surgical remo val should be considered as a preferred treatment option in these pati ents. (C) 1998 Wiley-Liss, Inc.