COMPARISON OF CLINICAL, HISTOLOGICAL, AND VIROLOGICAL SYMPTOMS OF HPVIN HIV-1-INFECTED MEN AND IMMUNOCOMPETENT SUBJECTS

Objective: We assessed the clinical, histological, and virological fea tures of anogenital human papillomavirus (HPV) infection, according to their immune status in HIV-1 infected men, referred for an anogenital examination or treatment, in comparison with immunocompetent patients . Methods: The study population comprised 33 HIV-1 infected heterosexu al or homosexual men and 38 HIV negative men seen in a screening and t reatment centre for anogenital HPV infections. All patients were exami ned with a colposcope. Biopsies were carried out on all subjects with anogenital lesions for histological studies and HPV detection by South ern blot. Results: The HN infected patients had a balanopreputial HPV infection in 70%, anal in 30%, and urethral in 37%, while HIV negative patients had balanopreputial lesion in 72%, anal in 26%, and urethral in 16%. Diffuse anogenital lesions were present in 33% of the HIV inf ected cases and in 10.5% of HIV negative cases (p<0.02). Among the HIV infected patients, the genital HPV lesions were condylomatous in 67.5 % of the cases and dysplastic in 57%. HIV negative patients had condyl omatous lesions in 86% of the cases and dysplasic in 14%. The condylom atous lesions of HIV infected patients had a low grade malignant histo logical aspect in 36% of the cases and high grade histological criteri a were found in 22% of the dysplasias. Oncogenic HPVs were detected mo re frequently in HIV infected patients (35% v 12%) and more than one H PV type was found in 21.5% of cases. Neither the anogenital diffusion of the HPV lesions nor their morphological, histological, and virologi cal features differed significantly in patient with CD4 cell counts > or < 200 x 10(6)/1. In contrast, patients with CD4 cell counts < 50 x 10(6)/1 had a higher risk of several types of HPVs and of developing a diffuse anogenital infection. Conclusion: HIV-1 infected patients had an increased frequency of high grade anogenital dysplastic lesions an d a higher frequency of HPV infection with multiple and diffuse sites of involvement. These characteristics of HPV infection were independen t of the patients' immune status up to CD4 cell counts > 50 x 10(6)/1 but showed an increased risk when the CD4 cell count was < 50 x 10(6)/ 1. The higher frequency of diffuse anogenital infections among HN infe cted men calls for rapid treatment, laser or surgery, given the associ ation of histological features of intraepithelial neoplasia and the pr esence of multiple HPV infection sites which may be the consequence of immune disturbances, most of which are transmissible potentially onco genic HPVs.