Condylomata Acuminata of HIV-Positive Men May Harbor Focal Areas of Dysplasia: Relevant Implications for the Management of Human Papillomavirus-Induced Disease in High-Risk Patients

The document discusses the implications of a study by Siegenbeek van Heukelom et al. on human papillomavirus (HPV)-induced disease in HIV-positive men, particularly those who have sex with men (MSM). The study analyzed 42 intra-anal warts for HPV genotyping and found that 23.8% of these anal condylomata contained focal areas of high-grade dysplasia, despite being clinically similar to benign anogenital warts. Histopathological analysis and laser capture microdissection were used to identify these areas of dysplasia. Interestingly, in four cases of intra-anal condylomata with high-grade dysplasia, only low-risk HPV types (HPV6 or HPV11) were detected, and p16 immunostaining was negative. These findings suggest that even low-risk HPV types can induce high-grade dysplasia in immunosuppressed individuals and that all HPV-induced lesions in high-risk patients, such as HIV-positive MSM, should be thoroughly analyzed histopathologically to detect high-grade anal intraepithelial neoplasia (AIN) and prevent the progression to invasive anal cancer. The study emphasizes the importance of early detection and treatment of HPV-induced anogenital lesions in high-risk patients.