Anal Condylomata: differences between HIV + and HIV - patients

Background Anogenital warts represent the most frequently diagnosed STI worldwide. Recurrences are high. Human Papillomavirus (HPV) infection is emerging as an important factor in the oncogenesis of various squamous cancers. Methods At our Department, 1,153 patients (758 M and 395 F) were diagnosed as affected by anal and perianal condylomata in a period from October 1999 and October 2010. Mean age was 34.7 years. One hundred and sixty-five patients (14.3%) were HIV+, 6.1% HBV+, and 2.6% HCV+. Ninety-four percent presented a perianal localization, 62% an endoanal (4.6% only endoanal), and 35.8% a genital localization. Nine hundred and sixty-seven patients were submitted to surgery in one or more sessions. Results Postoperative complications occured in 50 patients (5.2%): 42 were HIV- patients, 6 patients were HIV+ (3.6%), and the further two were not submitted to the test. Considering HIV+ patients complications occurred in patients with a mean CD 4+ count of 215 versus a mean CD 4+ count of 390 in HIV+ patients who did not have a complication. Recurrences occurred in 18.81% of HIV- patients (13.21% within 1 month and 5.6% within 6 months of follow up) and in 23% of HIV+ patients (15.15% within 1 month and 7.8% within 6 months of follow up). No differences in CD4+ counts were observed (respectively, 378 vs. 419). Progression to a neoplastic lesion was observed in 62 patients (6.4%). Forty-eight of these patients were HIV+ (77.48% of degenerations); and 2 patients were immunosuppressed (3.2%). Other 24 patients were immunocompetent. In our review of the literature, progression of condylomata to a neoplastic lesion occurs in 29% of HIV+ patients versus 2.4% of HIV- patients. Conclusions HIV infection influences neoplastic progression in patients affected by anal condylomata. Postoperative complications and recurrences are not influenced by HIV status.