Imiquimod 5% cream for external genital or perianal warts in human immunodeficiency virus-positive patients treated with highly active antiretroviral therapy: an open-label, noncomparative study

• Published in: British journal of dermatology (1951) Vol. 161; no. 4; pp. 904 - 909
• Main Authors: Saiag, P., Bauhofer, A., Bouscarat, F., Aquilina, C., Ortonne, J.P., Dupin, N., Mougin, C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2009; Wiley
• Subjects: Adjuvants, Immunologic; Adjuvants, Immunologic - administration & dosage; Administration, Cutaneous; Adolescent; Adult; AIDS-Related Opportunistic Infections; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - virology; Aminoquinolines; Aminoquinolines - administration & dosage; anogenital warts; Antiretroviral Therapy, Highly Active; Anus Diseases; Anus Diseases - drug therapy; Anus Diseases - virology; Cancer; Condylomata Acuminata; Condylomata Acuminata - drug therapy; Condylomata Acuminata - virology; Drug Administration Schedule; Female; highly active antiretroviral therapy; human immunodeficiency virus; Human papillomavirus; Humans; imiquimod; Kaplan-Meier Estimate; Kaplan-Meiers Estimate; Life Sciences; Male; Middle Aged; Papillomavirus Infections; Papillomavirus Infections - drug therapy; Papillomavirus Infections - virology; Treatment Outcome; Young Adult
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2009.09210.x

Summary
Background  Human immunodeficiency virus (HIV)+ patients have an increased risk of anogenital warts. High‐risk (HR) human papillomaviruses (HPVs), especially types 16 and 18, are major risk factors for precancerous and cancerous lesions of the anogenital tract, while low‐risk (LR) HPVs are associated with benign lesions. Cure of genital warts with ablative techniques, surgical excision, podophyllotoxin or trichloroacetic acid is frequently difficult. Treatment with imiquimod cream showed a total clearance of external genital or perianal warts in about 50% of immunocompetent subjects. However, total clearance was reduced in HIV+ subjects not treated with highly active antiretroviral therapy (HAART).
Objectives  To assess clinically and by monitoring HPV content the efficacy of 5% topical imiquimod to treat anogenital warts in HIV+ subjects with at least partially restored immune functions.
Methods  Fifty HIV+ patients successfully treated with HAART (total CD4+ cells ≥ 200 cells mm−3 and plasma HIV RNA load < 104 copies mL−1) with anogenital warts were included. Imiquimod 5% cream was applied on external genital or perianal warts three times weekly for up to 16 weeks. Warts were tested at entry and after treatment for human LR‐ and HR‐HPV DNA.
Results  Total wart clearance was observed in 16 of 50 (32%) patients at week 16. At enrolment, HPV DNA was present in more than 90% of lesions with a majority of lesions co‐infected by HR‐ and LR‐HPV. At study end, the HPV load decreased or became undetectable in 40% of cases studied.
Conclusions  Imiquimod 5% cream did not show safety concerns and is suitable for use in HIV+ subjects with anogenital warts and successful HAART treatment.