Imiquimod leads to a decrease of human papillomavirus DNA and to a sustained clearance of anal intraepithelial neoplasia in HIV-infected men
Alexander Kreuter, Anja Potthoff, Norbert H Brockmeyer, Thilo Gambichler, Markus Stücker, Peter Altmeyer, Jochen Swoboda, Herbert Pfister, Ulrike Wieland, German Competence Network HIV/AIDS, Axel Adam, Knud Schewe, Lutwin Weitner, K Aratesh, Gabriele Arendt, Clemens Bartz, Georg Behrens, Matthias Beichert, Bernhard Bieniek, Christiane Cordes, Michael Bochow, Norbert Brockmeyer, Bernd Buchholz, J R Bogner, Thomas Buhk, Andreas Clad, Martin Dannecker, St Dupke, Regina von Einsiedel, Stefan Esser, G Faetkenheuer, K Fischer, Matthias Freiwald, U Friebe-Hoffmann, S Fenske, Markus Funk, R Ganschow, Andrea Gingelmaier, Tobias Glaunsinger, F D Goebel, Jörg Gölz, Ilse Grosch-Wörner, Annette Haberl, Osamah Hamouda, Thomas Harrer, M Hartmann, H Hartl, Michael Hölscher, M Hower, I W Husstedt, K Jansen, Hans Jäger, H Jessen, A Jessen, M Karwat, Gerd Klausen, Frank Kirchhoff, H Knechten, Siegfrid Köppe, A Kreuter, B Kuhlmann, P Langer, Lauenroth-Mai, Walter Lehmacher, Michael Lehmann, C Levin, M Lübke, M Maschke, Ulrich Marcus, St Mauss, A Meyerhans, Dirk Meyer-Olson, V ter Meulen, Claudia Michalik, Arend Moll, F A Mosthaf, A Mutz, E Neuen-Jacob, T Niehues, M Oette, U Paulus, Andreas Plettenberg, Anja Potthoff, Paul Racz, Klara Racz, H Rasokat, Michael Rausch, D Reichelt, Anke Reitter, A Rieke, Jürgen Rockstroh, B Salzberger, A Schafberger, J Schauer, Frank Schlote, Barbara Schmidt, Dietmar Schranz, S Scholten, Christoph Schuler, Matthias Schwab, Wolfgang Schmidt, R Schmidt, Siegfried Schwarze, Winfred Siffert, A Skaletz-Rorowski, Ulrike Sonnenberg-Schwan, S Sopper, Ulrich Spengler, S Staszewski, Elfriede Steffan, Hans-Jürgen Stellbrink, Matthias Stoll, Tamme Goecke, Steffen Taubert, Anja Telschik, Albrecht Ulmer, Reiner Ullrich, Klaus Uberla, Susanne Usadel, Martin Vogel, R Wagner, Hauke Walter, K Warnatz, Jürgen Wasem, Werner Wiesel, K Von Weizsäcker, U Wieland, Uwe Wintergerst, Eva Wolf, Hans Wolf, Th Wünsche, Ch Wyen, M Zeitz, Vera Zylka-Menhorn, Alexander Kreuter, Anja Potthoff, Norbert H Brockmeyer, Thilo Gambichler, Markus Stücker, Peter Altmeyer, Jochen Swoboda, Herbert Pfister, Ulrike Wieland, German Competence Network HIV/AIDS, Axel Adam, Knud Schewe, Lutwin Weitner, K Aratesh, Gabriele Arendt, Clemens Bartz, Georg Behrens, Matthias Beichert, Bernhard Bieniek, Christiane Cordes, Michael Bochow, Norbert Brockmeyer, Bernd Buchholz, J R Bogner, Thomas Buhk, Andreas Clad, Martin Dannecker, St Dupke, Regina von Einsiedel, Stefan Esser, G Faetkenheuer, K Fischer, Matthias Freiwald, U Friebe-Hoffmann, S Fenske, Markus Funk, R Ganschow, Andrea Gingelmaier, Tobias Glaunsinger, F D Goebel, Jörg Gölz, Ilse Grosch-Wörner, Annette Haberl, Osamah Hamouda, Thomas Harrer, M Hartmann, H Hartl, Michael Hölscher, M Hower, I W Husstedt, K Jansen, Hans Jäger, H Jessen, A Jessen, M Karwat, Gerd Klausen, Frank Kirchhoff, H Knechten, Siegfrid Köppe, A Kreuter, B Kuhlmann, P Langer, Lauenroth-Mai, Walter Lehmacher, Michael Lehmann, C Levin, M Lübke, M Maschke, Ulrich Marcus, St Mauss, A Meyerhans, Dirk Meyer-Olson, V ter Meulen, Claudia Michalik, Arend Moll, F A Mosthaf, A Mutz, E Neuen-Jacob, T Niehues, M Oette, U Paulus, Andreas Plettenberg, Anja Potthoff, Paul Racz, Klara Racz, H Rasokat, Michael Rausch, D Reichelt, Anke Reitter, A Rieke, Jürgen Rockstroh, B Salzberger, A Schafberger, J Schauer, Frank Schlote, Barbara Schmidt, Dietmar Schranz, S Scholten, Christoph Schuler, Matthias Schwab, Wolfgang Schmidt, R Schmidt, Siegfried Schwarze, Winfred Siffert, A Skaletz-Rorowski, Ulrike Sonnenberg-Schwan, S Sopper, Ulrich Spengler, S Staszewski, Elfriede Steffan, Hans-Jürgen Stellbrink, Matthias Stoll, Tamme Goecke, Steffen Taubert, Anja Telschik, Albrecht Ulmer, Reiner Ullrich, Klaus Uberla, Susanne Usadel, Martin Vogel, R Wagner, Hauke Walter, K Warnatz, Jürgen Wasem, Werner Wiesel, K Von Weizsäcker, U Wieland, Uwe Wintergerst, Eva Wolf, Hans Wolf, Th Wünsche, Ch Wyen, M Zeitz, Vera Zylka-Menhorn
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.
Source: PubMed