HIV infection is a risk factor for external genital warts, study suggests

The development and recurrence of cervical lesions associated with the human papillomavirus (HPV) are more common in HIV-infected women than in HIV negative women, according to an Italian study of 1,336 patients.

Relapses after treatment for external genital warts were more common in women with HIV than in those without, report Dr Giuseppe De Panfilis and colleagues at the Department of Dermatology at Brescia Hospital, Brescia, Italy, in the March issue of the journal Sexually Transmitted Diseases. They advise clinicians to encourage patients with recurring genital warts to be tested for HIV.

Dr De Panfilis and colleagues compared relapses after treatment for external genital warts in 241 HIV-positive and 1,095 HIV-negative patients examined between 1990 and 1999 at the STD centre at Brescia. Various local treatments were used.

Treatment generally triggered recovery from the lesions, report the researchers, but the relapses observed up to one year after response, examined by survival analysis, were significantly (P < 0.001) more frequent in the HIV-positive (160 cases, 66.4%) than in the HIV-negative (294 cases, 26.8%) subjects. Multiple relapses observed up to one year after treatment occurred in 69 of 241 HIV-positive patients, as compared with 14 of 1,095 HIV-negative subjects (P < 0.001).

A comparable pattern of recurrences of cervical intraepithelial neoplasia (CIN), which like genital warts are also associated with HPV, was also observed by Dr De Panfilis and colleagues. In 127 HIV-positive women referred for CIN evolution, recurrences continued to develop after treatment, reaching 62% by three years. However, CIN recurred in only 18% of 193 HIV-negative patients over a similar time period.

The authors write: “Thus, as with CIN, we can assume that the natural histories of external genital warts after treatment in HIV-positive and HIV-negative subjects are distinct.”

And they conclude: “According to the study findings, HIV infection can be considered a risk factor for the development and recurrence of external genital warts. Multiple relapses should drive patients to HIV testing.”