Anogenital Warts May Be Cancerous in HIV-Positive Men Who Have Sex With Men

By Marilynn Larkin

August 05, 2016

NEW YORK (Reuters Health) - Human papillomavirus (HPV)-induced anogenital warts in HIV-positive men who have sex with men (MSM) "may harbor high-grade dysplasia or even invasive squamous cell carcinoma," researchers from Germany report.

"HIV-positive patients, especially HIV-positive MSM, have a significantly increased risk for HPV-induced anogenital lesions such as condylomas, anogenital dysplasias, and invasive cancers," Dr. Alexander Kreuter of the University of Witten-Herdecke told Reuters Health by email. "Condylomas are usually considered benign, or low-grade, lesions, and some researchers have suggested a 'wait and see' strategy in the case of such lesions."

However, as reported by Dr. Kreuter and colleagues in JAMA Dermatology, online July 27, a substantial proportion of HPV-induced anogenital lesions that clinically appear as common warts may actually be cancerous.

The team conducted a retrospective viral analysis of tissue from dysplasia-containing anogenital warts from 25 HIV-positive MSM and tissue from anogenital warts from 22 HIV-negative patients.

Of 38 dysplasia-containing anogenital warts from the HIV-positive MSM, six (16%) exhibited low-grade dysplasia, 31 (81%) harbored high-grade dysplasia and one (3%) had areas of invasive anal carcinoma.

All low-grade lesions except one were negative for p16INK4a (a tumor suppressor protein), whereas 25 of 31 (81%) anogenital warts with high-grade lesions or an anal carcinoma were p16INK4a-positive.

Further analysis revealed only low-risk HPV-types were present in 11 samples (29%); low-risk and high-risk HPV types were present in 19 samples (50%); and eight samples (21%) had only high-risk HPV-types.

Dr. Kreuter observed, "In some of these lesions, only low-risk HPV-types were found. (Therefore), low-risk HPV types are not completely 'innocent' in immunosuppressed individuals, as was previously shown for giant condyloma of Buschke and Löwenstein."

The 22 anogenital warts from HIV-negative patients showed no signs of dysplasia, and p16INK4a-staining was consistently negative. All of these samples carried low-risk HPV types, although additional high-risk HPV-types were detected in two cases.

"We recommend treating all HPV-associated anogenital lesions and obtaining tissue for further histopathological analysis," Dr. Kreuter said. "We also suggest including Ki67 and p16 immunostaining of such lesions in order to exclude focal dysplasia. We think that a 'wait and see' strategy is inappropriate in immunocompromised patients."

Dr. Kurt Melstrom, a surgical oncologist at City of Hope in Duarte, California, told Reuters Health by email that the study findings have "important clinical implications for two sets of physicians. The first is the patient's primary HIV physician. He or she should be more diligent about the anal exam and should refer patients out to a surgical specialist when any abnormalities are seen."

"For the surgeon, the results of this study point to thorough anorectal exams with high-resolution anoscopy," Dr. Melstrom continued. "When any lesions are encountered, they should be biopsied and the location in the anal canal noted. This is a departure from current treatment, which is usually fulguration or destruction of the lesions without directed biopsies."

No commercial funding or conflicts of interest were reported.

SOURCE: http://bit.ly/2aWxjzT

JAMA Dermatol 2016.

Cite this article: Anogenital Warts May Be Cancerous in HIV-Positive Men Who Have Sex With Men. Medscape. Aug 04, 2016.