Spectrum and progression of disease from condyloma to aggressive anogenital squamous cell carcinoma in 3 HIV-positive patients

AIN: anal intraepithelial neoplasia ARV: antiretroviral CA: condyloma acuminata HPV: human papillomavirus MSM: man who has sex with men SCCIS: squamous cell carcinoma in situ INTRODUCTION Human papillomavirus (HPV) is the causative agent of condyloma acuminata (CA). Although it is often assumed that CA are caused by HPV subtypes distinct from those that lead to squamous cell carcinoma, this is not always the case, particularly in immunocompromised patients. A greater percentage of HIV-positive men are infected with multiple HPV subtypes within their CA than their HIV-negative counterparts, with lower CD4 counts associated with higher levels of oncogenic HPV DNA. In addition, HIV-positive individuals have a higher prevalence and incidence of HPV-associated anal intraepithelial neoplasia (AIN) and anogenital cancers than their HIV-negative counterparts. Furthermore, many instances of malignant transformation of CA have been described. Here we show the spectrum and progression of disease from CA to aggressive anogenital squamous cell carcinoma in 3 HIV-positive patients and stress the diversity of clinical presentations that can exist in this patient population. Immunosuppression from HIV infection, co-infection with multiple HPV subtypes including oncogenic strains, a history of a low CD4 nadir, and the inability to adequately clear the HPV puts patients at a much greater risk of malignant progression of HPV-associated skin lesions, which can be rapid in some cases. Hence, it is critical that dermatologists screen patients and those affected receive close clinical monitoring, disease surveillance, and appropriate prompt treatment.