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Human papillomavirus-associated diseases in HIV-infected men who have sex with men

Kreuter, Alexandera; Wieland, Ulrikeb

Current Opinion in Infectious Diseases: April 2009 - Volume 22 - Issue 2 - p 109–114
doi: 10.1097/QCO.0b013e3283229fc8
Skin and soft tissue infections: Edited by Roderick J. Hay

Purpose of review Persistent human papillomavirus (HPV) infection is very frequent in HIV-positive men who have sex with men. This review summarizes recent data on papillomavirus-induced anal intraepithelial neoplasia and anal cancer in these patients. Moreover, data are provided on penile and oral HPV-associated diseases, for which only limited information is available in the literature.

Recent findings The incidence of anal intraepithelial neoplasia rises in HIV-positive men who have sex with men despite the introduction of highly active antiretroviral therapy. Increasing evidence indicates that high-grade lesions can progress to anal cancer over time. Anal cytology has been recommended as the primary screening tool for anal dysplasia in the at-risk population. Individuals with abnormal cytology should undergo high-resolution anoscopy to appropriately identify and treat dysplastic lesions. Anal cancer has become one of the most common non-AIDS-defining tumors in HIV-infected individuals. In the era of highly active antiretroviral therapy, the outcome of combined chemoradiotherapy in HIV-positive individuals with anal cancer is similar to that in HIV-negative persons. Penile and oral HPV-associated diseases seem to be more frequent in HIV-positive men than reported for HIV-negative heterosexual men.

Summary Diagnostic and therapeutic guidelines should be implemented for at-risk populations for anal dysplasia/anal cancer, such as HIV-positive men who have sex with men. More study is required to get better insights into the natural history of penile and oral HPV-associated benign and malignant lesions.

aDepartment of Dermatology, Ruhr University Bochum, Bochum, Germany

bInstitute of Virology, University of Köln, Cologne, Germany

Correspondence to Alexander Kreuter, MD, Department of Dermatology, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany Tel: +49 234 509 3439; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.