Human papillomavirus anogenital lesions in 121 HIV-positive men: clinical,histological, viral data, and outcome

Objective. To determine the prevalence of the Human Papillomavirus (HPV) in Human Immunodeficiency Virus (HIV) infected men, using clinical examinatio n and molecular hybridization in situ. Patients and methods. From May 1995 to May 1997 we studied the prevalence, clinical and histological characteristics, the types and the evolution of t he HPV lesions among 121 HIV-infected men. The HPV DNA was determined by mo lecular hybridization in situ, using biotinylated probes which recognized H PV types 6/11, 16/18 and 31/33/35 in 79 p. 100 (5/19) of the patients (17 b iopsies). Results. Sixteen per cent (19/121) Of the patients are HPV infected: genita l warts in 37 p. 100 (7/19), anal warts in 37 p, 100 (7/19), and ano-genita l warts in 26 p, 100 (5/19) of the patients. In every case of anal condylom a, intracanalar lesions were found. In 47 p. 100 (9/19) of the cases, histo logical examen showed an intraepithelial neoplasia. The HPV types 6/11, 16/ 18 and 31/33/51 were positive in 53 p. 100 (9/17), 35 p. 100 (6/17) and 35 p. 100 (6/17) biopsies respectively. Highrisk types of HPV have been noted in 71 p. 100 (12/17) of the biopsies. The evolution of the clinical lesions was: recovering in 47 p. 100 (9/19) of the patients (after 3 months of tre atment), recurrence in 16 p, 100 (3/19) of the anal warts (after 1 to 3 mon ths of treatment), stabilization in 16 p. 100 (3/19) of the genital warts ( after 6 months of treatment) and extension in 11 p. 100 (2/19) of the anoge nital warts (after 3 months of treatment). Conclusion. The high prevalence of condyloma and dysplasia emphasizes the i mportance of the anogenital examen in HIV-positive patients. In case of ana l lesions, anuscopy and biopsy are required. We insist on the need to close ly follow these patients with HPV lesions in order to adapt treatment. Anal cytology and HPV-DNA detection by Hybrid Capture Assay, should be develope d for screening and prevention of the malignant transformation of HPV lesio ns in this population.