HPV Virus Medical - Pictures - Treatment

Wollina U. Department of Dermatology, Hospital Dresden-Friedrichstadt, Dresden, Germany.

BACKGROUND AND OBJECTIVES: Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser(Er:YAG) with a wavelength of 2.94 rm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non-responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)-induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard-to-treat palmoplantar HPV warts was investigated. PATIENTS AND METHODS: Thirty-five patients with hard-to-treat warts(palmar or plantar) with a mean age of (32.2+12.1) years, range 17-50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7-11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed. RESULTS: After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes,wound infections or scarring. CONCLUSION: The therapy of hard-to-treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.

Pediatr Dermatol. 2003 Sep-Oct;20(5):440-2.

Imiquimod is highly effective for extensive, hyperproliferative condyloma in children.

Majewski S, Pniewski T, Malejczyk M, Jablonska S. Department of Dermatology and Venereology, Warsaw School of Medicine, Warsaw, Poland.

We describe a dramatic response to imiquimod of long-lasting, highly proliferative extensive perianal condylomas involving the anal canal in a 19-month-old girl. Her mother was free of condyloma and allegedly had no human papillomavirus (HPV) infection during pregnancy. There was no evidence of sexual abuse. Application of 5% imiquimod cream to the child every other day for 3 weeks resulted in almost complete resolution of the warts, with total clearance within another 2 weeks. The inflammatory reaction was moderate. Since there is still discussion of whether imiquimod may be prescribed for small children, this case of very extensive condyloma provides evidence that the compound is safe and highly effective.

Publication Types:
• Case Reports

Drugs Today (Barc). 1999 Jul;35(7):497-511.

Imiquimod.

Richwald GA. Sexually Transmitted Diseases Program, Los Angeles County Department of Health Services, Los Angeles, California, USA.

The imidazoquinoline, imiquimod, is a low molecular weight, synthetic immune response modifier that is used for the treatment of external genital and perianal warts. It is formulated in a 5% vanishing cream as Aldara. This self-applied therapy has shown good efficacy and safety in the treatment of external genital and perianal warts caused by human papillomavirus (HPV) infection. The antiviral mechanism of action of this compound is unlike any other approved antiviral therapy in that it induces the production of antiviral cytokines and cytokines that enhance cellular immunity believed to be necessary for the control or elimination of HPV infection. Imiquimod does not exert its antiviral effects directly on virus-infected cells. Treatment with imiquimod results in resolution of wart tissue and reduction of viral burden. Post-marketing trials using imiquimod demonstrated that patients who experience complete clearance of either new or recalcitrant warts tend to remain clear for longer periods as compared to other treatment modalities. Preclinical data demonstrate in vitro and in vivo that imiquimod directly induces antiviral and immunomodulating cytokines from monocytes, macrophages and dendritic cells. These immunomodulating cytokines have been shown to potentiate Th1 immunity. Self-application, good tolerability, a unique mechanism of action and a relatively high sustained clearance rate combine to make imiquimod a cost-effective first-line therapy for external genital warts and an appropriate second-line therapy when other treatments are unsuccessful. In small-scale studies requiring replication, imiquimod has also been shown to be effective in the treatment of non-HVP-related skin infections and some dermal neoplasias. (c) 1999 Prous Science. All rights reserved.

Expert Rev Vaccines. 2003 Jun;2(3):381-9.

Progress in prophylactic and therapeutic vaccines for human papillomavirus infection.

Stanley MA. Department of Pathology, Cambridge, UK. mas@mole.bio.cam.ac.uk

Virus-like particle (VLP) subunit vaccines composed of the major capsid protein L1 of the genital human papillomaviruses (HPVs) are now in Phase III clinical trials. The vaccines are immunogenic and safe and early results indicate efficacy. VLPs induce strong cell-mediated as well as humoral immune responses and chimeric VLPs including an HPV early protein may have therapeutic potential. Polynucleotide and recombinant viral vaccines encoding nonstructural viral proteins show therapeutic and prophylactic efficacy in animal models and are candidate immunotherapies for established low-grade benign genital infections. Vaccines designed to elicit cytotoxic T-lymphocytes specific for the HPV oncoproteins E6 and E7 show immunogenicity and efficacy in transplantable tumor models in rodents. In Phase I and II trials these vaccines are immunogenic and safe but show limited efficacy.

Publication Types:
• Review
• Review, Tutorial

J Natl Cancer Inst Monogr. 2003;(31):117-24.

Chapter 17: Genital human papillomavirus infections--current and prospective therapies.

Stanley M. Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1Q0, UK. mas@mole.bio.cam.ac.uk

Many therapies are available for the treatment of human papillomavirus (HPV)-associated disease, particularly external genital warts. However, at present, these therapies aim to remove the lesion rather than specifically target HPV infection. When disease and infection are local, as in cervical intraepithelial neoplasia (CIN), excisional therapies removing lesion and transformation-susceptible cells are highly effective. However, when infection is regional, as is usually the case for the anogenital warts, vulval intraepithelial neoplasia (VIN), anal intraepithelial neoplasia (AIN), penile intraepithelial neoplasia, and vaginal intraepithelial neoplasia, then current treatments are generally inadequate, with high recurrence rates. Future therapies will be directly or indirectly antiviral, targeting HPV protein functions or enhancing the ability of the immune system to resolve infection or inducing apoptosis indirectly in HPV-infected cells. In the short to the medium term, immunotherapies for low-grade disease are the most likely to be in the clinic. Vaccines targeting the E1 and E2 early proteins combined with immunomodulators or conventional adjuvants that induce a strong cell-mediated HPV antigen-specific response and good immune memory would be the predicted combination. Vaccines designed to target high-grade intraepithelial disease, even when used in combination with immunomodulators, are unlikely to effect lesion clearance in more than a fraction of the cases. However, they may have a role as adjunct therapy after cervical conization to prevent the recurrence of CIN or HPV reinfection. They certainly appear to have a role in multifocal disease, such as VIN and AIN, where partial clearance may be effected and lesion size reduced enough for effective ablative or excisional therapy. It seems unlikely that anti-HPV chemotherapies specifically targeting HPV protein functions will be in the clinic in the medium term. However, agents such as indole-3-carbinol have shown efficacy in small clinical trials, and if these effects are confirmed in larger, randomized, placebo-controlled trials, they could be clinically useful.

Publication Types:
• Review
• Review, Tutorial

J Natl Cancer Inst Monogr. 2003;(31):111-6.

Chapter 16: Prophylactic human papillomavirus vaccines.

Lowy DR, Frazer IH. Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health/DHHS, Building 37, Room 4106, MSC 4263, Bethesda, MD 20892, USA. drl@helix.nih.gov

Candidate prophylactic vaccines based on papillomavirus L1 virus-like particles (VLPs) are currently in human clinical trials. The main long-term goal of the vaccine is to reduce the incidence of cervical cancer and its precursors. In animal papillomavirus models, systemic immunization with L1 VLPs can induce high titers of neutralizing antibodies that confer protection against high-dose experimental papillomavirus challenge. In humans, systemic vaccination with L1 VLPs has been well tolerated and induced high serum antibody titers (at least 40 times higher than titers seen following natural infection). A recent proof of principle HPV16 L1 VLP efficacy trial has shown excellent protection against persistent HPV16 infection and associated cytological abnormalities. Large scale efficacy trials of L1 VLPs from HPV16 and 18 (the HPV types found most frequently in cervical cancer), with or without HPV6 and 11 (the HPV types responsible for most genital warts), are planned. If the results of these large trials support the encouraging results of the early trials, they should lead to a commercial prophylactic HPV vaccine. Implementation issues may include how to make the vaccine available in the developing world, where the majority of cervical cancer cases occur, the appropriate age of vaccination, and the role of male vaccination. Because a VLP vaccine is likely to provide type-specific protection, increasing the number of cancer-associated HPV types in the vaccine is a likely approach to broadening the protection to additional types. There will probably also be efforts to develop alternative vaccine formulations better suited to implementation in developing countries as well as attempts to develop vaccines with a therapeutic activity against established HPV infection because a combined prophylactic/therapeutic vaccine may be expected to have an even greater impact than a purely prophylactic vaccine on HPV induced disease.

Publication Types:
• Review
• Review, Tutorial

Curr Opin Infect Dis. 2003 Apr;16(2):85-9.

Imiquimod.

Garland SM. Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Carlton, Victoria, Australia. suzanne.garland@wch.org.au

PURPOSE OF REVIEW: Imiquimod is the first member of a new class of immune response modifiers; it was first approved in 1997 for the topical treatment of external genital and perianal warts. It is an imidazoquinoline, a novel synthetic compound which is an immune response stimulator, enhancing both the innate and acquired immune pathways (particularly T helper cell type 1-mediated immune responses) resulting in antiviral, antitumour and immunoregulatory activities. The mechanism of action of imiquimod involves cytokine induction in the skin, which then triggers the host's immune system to recognize the presence of a viral infection or tumour, ultimately to eradicate the associated lesion. RECENT FINDINGS: Imiquimod, a patient-applied topical 5% cream is clinically efficacious and safe in the management of condylomata acuminata and other warty manifestations of human papillomavirus infections. Although not licensed for use against other viral skin infections, preliminary data suggest imiquimod's success against molluscum contagiosum, caused by a poxvirus. Initial studies with imiquimod for the management of HPV-related intraepithelial dysplasias (bowenoid papulosis/vulvar intraepithelial neoplasia) as well as for ultraviolet-induced skin lesions such as actinic keratoses, Bowen's disease, and basal cell carcinomas show great promise in immunocompetent and immunosuppressed patients. SUMMARY: In the future, imiquimod and newer generations of imidazoquinolines (resiquimod) require further investigation for potential clinical utility in treating other cutaneous and mucosal viral infections, dysplasias and neoplasia, as well as potential vaccine adjuvants.

Publication Types:
• Review
• Review, Tutorial

HPV Virus Medical - Methods of HPV Treatment Links

Danger of HPV - Information on dealing with HPV and its manifestations.

HPV - The Most Common Sexually Transmitted Virus - Here you'll find information on various methods to remove genital warts and on how to protect yourself from this infection.