A sexually transmitted virus called HPV (human papilloma virus) can cause warts to appear on or around the genitals and anus. Certain strains of HPV can also cause cervical and anal cancer. In HIV positive people, HPV-related warts can be troublesome. Although doctors can treat the warts — using liquid nitrogen, lasers, surgery — the warts usually recur because the underlying problem is one of weakened immunity.

Doctors in Milan, Italy, recently completed a study comparing the effects of different therapies on HPV-related warts in HIV positive subjects. The doctors found that a combination of surgery and treatment with the antiviral drug cidofovir (Vistide) was most useful in suppressing regrowth of warts.

Study details

Researchers recruited 74 subjects with the following profile:

• 28% female, 72% male
• average age – 33 years
• average CD4+ count – 265 cells
• average viral load – 35,000 copies
• 50 subjects were taking anti-HIV drugs

Warts were found in the following locations in the following proportions of subjects:

• on the penis – 51%
• around the anus – 21%
• around the vulva – 21%
• between the anus and genitals – 4%

Researchers randomly assigned subjects to receive one of the following three interventions:

• electro-surgery – burning of warts using a weak electrical current
• 1% cidofovir gel – this was applied to the warts five days weekly for up to six weeks
• electro-surgery and cidofovir – within a month of surgery, subjects applied cidofovir gel five days weekly for only two weeks to the affected area

Results – short-term

Not surprisingly, over the short-term, electro-surgery was more successful than cidofovir in removing warts.

Results – long-term

Of the 66 subjects whose warts cleared in the short-term, 47 returned to the study team for monitoring over the next six months. Warts reappeared in the following groups:

• electro-surgery alone – 74%
• cidofovir alone – 35%
• combined surgery followed by cidofovir – 27%

Recurrence of warts was not related to subjects' CD4+ counts. It is possible that a longer application of cidofovir — more than two weeks — following surgery may provide better suppression of warts. But this needs to be balanced with the potential for side effects, as between 32% and 42% of subjects who used cidofovir developed skin irritation. In three subjects the irritation was so severe that they had to stop using this drug.

REFERENCE

Orlando G, Fasolo MM, Beretta R, et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients. AIDS 2002;16(3):447-450.

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