Imiquimod leads to a decrease of human papillomavirus DNA and to a sustained clearance of anal intraepithelial neoplasia in HIV-infected men.

Abstract

Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-associated precursor lesion of anal carcinoma, is highly prevalent in HIV-infected men having sex with men (MSM). This prospective follow-up study evaluated the long-term results of imiquimod treatment of AIN in 19 HIV-infected MSM. Standardized follow-up examinations included high-resolution anoscopy, anal cytology/histology, HPV typing, and DNA load determination for HPV types 16, 18, 31, and 33. Mean follow-up time was 30.3 months. A total of 74% (14/19) of the patients remained free of AIN at the previously treated site. Five patients (26%) had recurrent high-grade AIN after a mean time of 24.6 months. At the end of follow-up, the numbers of HPV types as well as high-risk HPV-DNA loads were significantly lower than before therapy. During follow-up, 58% of all patients (11/19) developed new anal cytological abnormalities in previously normal, untreated anal regions. 55% of these new AIN lesions were high-grade lesions and most of them were located intra-anally and associated with high-risk HPV types not detectable before therapy. These results demonstrate that imiquimod leads to a high rate of long-term clearance of AIN in HIV-positive men together with a prolonged decrease of high-risk HPV-DNA load. However, new AIN lesions associated with previously undetected HPV types frequently occur in untreated areas.

• Authors: Alexander Kreuter, Anja Potthoff, Norbert H Brockmeyer, Thilo Gambichler, Markus Stücker, Peter Altmeyer, Jochen Swoboda, Herbert Pfister, Ulrike Wieland, German Competence Network HIV/AIDS
• Journal: The Journal of investigative dermatology (J Invest Dermatol) Vol. 128 Issue 8 Pg. 2078-83 (Aug 2008) ISSN: 1523-1747 [Electronic] United States
• PMID: 18273049 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Aminoquinolines
• Antineoplastic Agents
• DNA, Viral
• Imiquimod

Topics

• Aminoquinolines (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Anus Neoplasms (drug therapy, pathology, virology)
• Carcinoma in Situ (drug therapy, pathology, virology)
• DNA, Viral (drug effects)
• Follow-Up Studies
• HIV Infections (complications)
• Human papillomavirus 16 (genetics)
• Human papillomavirus 18 (genetics)
• Humans
• Imiquimod
• Longitudinal Studies
• Male
• Papillomaviridae (genetics)
• Prospective Studies
• Treatment Outcome