Abstract #110  -  The persistence of significant human papillomavirus related mucocutaneous disease and neoplasia in the era of antiretroviral medications
Authors:   Presenting Author:   Dr Carrie Kovarik - University of Pennsylvania
Additional Authors:  Dr.  Carrie  Kovarik, Ms.  Rachel Gormley,
Aim: The aim of this presentation is to highlight the burden of persistent Human Papillomavirus (HPV) related skin and mucosal disease and neoplasia in HIV infected patients, despite immune reconstitution with antiretroviral medications.
Method / Issue: The interaction between HIV and HPV is complex, but a combination of direct HPV-HIV viral molecular interactions, as well as decreased local immune control of HPV infection in the context of HIV immunosuppression, may result in enhanced HPV replication, with increased persistence and severity of clinical disease. The beneficial effect of highly active antiretroviral therapy may be less pronounced when HPV-related disease has progressed with immunosuppression, because HPV-specific immunity has been irreversibly damaged, or HPV related changes have persisted long enough the sufficient genetic changes have accumulated by the time of HAART initiation.
Results / Comments: Since the introduction of highly active antiretroviral therapy (HAART), there has been a dramatic reduction in mortality in HIV infected patients, but rates of malignancy, including HPV-related cervical, anal, penile, vulvar, and cutaneous squamous cell cancers, in HIV patients have not normalized. In addition, persistence of extensive HPV-related skin disease despite immune reconstitution can be debilitating and psychologically devastating. HIV infected patients may continue to have severe genital, common, and flat warts, with few effective therapies.
Discussion: HAART therapy, especially when initiated late, may have minimal beneficial effects on HPV-related skin disease in HIV patients. Disease can be resistant to conventional therapy with high rates of recurrence and progression. It is critical that clinicians are educated in the clinical diagnosis of HPV-related mucocutaneous disease, and these patients need to undergo careful screening of both anogenital and non-genital skin.
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