Diagnosis and Management of Genital Warts in HIV Disease

Giovanna Orlando, MD, Maria Michela Fasolo, MD, Rosangela Beretta, MD, Antonietta Cargnel, MD


AIDS Read. 2000;10(1) 

In This Article

Clinical Features of Warts in Immunocompromised Patients

Genital warts can be seen inside the vagina and urethra, and on the uterine cervix, vulva, penis, and anus. Although in most cases genital warts are asymptomatic, they can be painful, friable, and pruritic depending on their size and location.

Extension and evolution of the lesions are affected by the host immune response. The exact immune mechanism involved in limiting HPV infection is still poorly understood,[10] but it is known that clearance of HPV requires an active cell-mediated immune response in addition to the mechanical surgical removal of lesions.[11] Coleman and colleagues[12] observed higher concentrations of macrophages and CD4+ cells of the "antigen-experienced" phenotype in the wart stroma and epithelium of regressing wart lesions compared with nonregressing lesions.

In patients co-infected with HIV, a particularly aggressive and extensive infiltration of the affected areas has been observed (Figures 1 and 2), and there appears to be a relationship between a high rate of lesion recurrence and the degree of immune impairment in these patients.[13,14] At our clinic, we observed a 37.5% relapse rate in 24 surgically cured patients within 3 months after treatment.[2] Higher rates of lesion relapse after treatment have been reported for both low-risk and high-risk neoplastic evolution subtypes.

Anal warts in a 38-year-old man who has been HIV-positive since 1985 with CDC stage III symptoms and a CD4+ cell count of 180/mL.

Penile warts in a 29-year-old man, HIV-positive since 1995 with CDC stage III symptoms and a CD4+ cell count of 350/mL.