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Fernando I, K Edwards S, Grover D. British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021). Int J STD AIDS 2022; 33:422-432. [PMID: 35312417 DOI: 10.1177/09564624211070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.
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Affiliation(s)
| | - Sarah K Edwards
- GU Medicine, 215332Cambridgeshire Community Services NHS Trust, Bury St Edmunds, UK
| | - Deepa Grover
- GUM/HIV Medicine, 4954Central and North West London NHS Foundation Trust, London, UK
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Martin P. Interventions for molluscum contagiosum in people infected with human immunodeficiency virus: a systematic review. Int J Dermatol 2016; 55:956-66. [PMID: 26991246 DOI: 10.1111/ijd.13267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Molluscum contagiosum (MC) is a viral skin disease that presents with white, painless papules with central umbilication. In immunocompent individuals, MC is usually a benign infection that resolves without intervention. In HIV positive people, symptoms of MC can be more severe. OBJECTIVE The aim of this systematic review is to analyze the literature on strategies for treating MC in people concomitantly infected with HIV and subsequently make recommendations on best management strategies for these people. METHOD Searches were conducted of the following electronic databases: MEDLINE, EMBASE, Cochrane Library, PubMed, LILACS, IndMED, Global Health, ClinicalTrials.Gov, and Current Controlled Trials. Grey literature was searched via the New York Academy of Medicine Grey Literature Report and Open Grey. References cited in previous reviews and references cited in studies identified as being possibly relevant were also reviewed. No language restrictions were imposed. Papers from 1980 to present were reviewed. RESULTS & DISCUSSION Thirteen studies were included in this review. Two papers were comparative studies, one of which was randomized and neither of which were blinded. Ten papers were observational studies with heterogeneous populations. One study was a multicentre cohort study. CONCLUSION Given the poor quality of study design, wide array of outcome variables, and lack of objective evidence, no specific recommendation can be made for the treatment of MC in people infected with HIV, other than the initiation of ART. Despite the good impact ART has made on prevalence of dermatologic disease, MC remains an important cause of morbidity in HIV positive populations.
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Affiliation(s)
- Paul Martin
- London School of Hygiene and Tropical Medicine, London, UK
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Meys R, Purdie KJ, de Koning MNC, Quint KD, Little AM, Baker F, Francis N, Asboe D, Hawkins D, Marsh SGE, Harwood CA, Gotch FM, Bunker CB. HLA Immunogenotype Determines Persistent Human Papillomavirus Virus Infection in HIV-Infected Patients Receiving Antiretroviral Treatment. J Infect Dis 2016; 213:1717-24. [PMID: 26908737 DOI: 10.1093/infdis/jiw038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/21/2016] [Indexed: 11/14/2022] Open
Abstract
A proportion of human immunodeficiency virus (HIV)-infected patients develop persistent, stigmatizing human papillomavirus (HPV)-related cutaneous and genital warts and anogenital (pre)cancer. This is the first study to investigate immunogenetic variations that might account for HPV susceptibility and the largest to date to categorize the HPV types associated with cutaneous warts in HIV-positive patients. The HLA class I and II allele distribution was analyzed in 49 antiretroviral (ART)-treated HIV-positive patients with persistent warts, 42 noninfected controls, and 46 HIV-positive controls. The allele HLA-B*44 was more frequently identified in HIV-positive patients with warts (P = .004); a susceptible haplotype (HLA-B*44, HLA-C*05; P = .001) and protective genes (HLA-DQB1*06; P = .03) may also contribute. Cutaneous wart biopsy specimens from HIV-positive patients harbored common wart types HPV27/57, the unusual wart type HPV7, and an excess of Betapapillomavirus types (P = .002), compared with wart specimens from noninfected controls. These findings suggest that HLA testing might assist in stratifying those patients in whom vaccination should be recommended.
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Affiliation(s)
| | - Karin J Purdie
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | | | - Koen D Quint
- DDL Diagnostic Laboratory, Rijswijk Department of Dermatology, Leiden University Medical Centre, The Netherlands
| | - Ann-Margaret Little
- Anthony Nolan Research Institute, Royal Free Hospital Cancer Institute, University College London, United Kingdom
| | | | - Nick Francis
- Department of Histopathology, Charing Cross Hospital, Imperial College London
| | - David Asboe
- Department of HIV Medicine and Sexual Health, Chelsea and Westminster Hospital
| | - David Hawkins
- Department of HIV Medicine and Sexual Health, Chelsea and Westminster Hospital
| | - Steven G E Marsh
- Anthony Nolan Research Institute, Royal Free Hospital Cancer Institute, University College London, United Kingdom
| | - Catherine A Harwood
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London
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Sanchez JL, Hunt PW, Reilly CS, Hatano H, Beilman GJ, Khoruts A, Jasurda JS, Somsouk M, Thorkelson A, Russ S, Anderson J, Deeks SG, Schacker TW. Lymphoid fibrosis occurs in long-term nonprogressors and persists with antiretroviral therapy but may be reversible with curative interventions. J Infect Dis 2014; 211:1068-75. [PMID: 25344521 DOI: 10.1093/infdis/jiu586] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Human immunodeficiency virus (HIV) replication causes lymphoid tissue (LT) fibrosis, which causes CD4(+) T-cell depletion. It is unknown whether people who spontaneously control HIV replication have LT fibrosis. We measured LT fibrosis and CD4(+) T cells in 25 HIV controllers, 10 noncontrollers, 45 HIV-positive individuals receiving therapy, and 10 HIV-negative individuals. Controllers had significant LT fibrosis and CD4(+) T-cell depletion, similar to noncontrollers, but the so-called Berlin patient (in whom HIV infection was cured) had near normal LT. Thus, LT fibrosis occurs in all HIV-infected subjects, and current therapy does not reverse it. Reversal of fibrosis during a curative intervention suggests that ongoing low-level virus production may maintain LT fibrosis.
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Fernando I, Pritchard J, Edwards SK, Grover D. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS 2014; 26:687-95. [PMID: 25332225 DOI: 10.1177/0956462414554435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jill Pritchard
- Sexual Health Ashford and St Peter's Hospital, Chertsey, Surrey, UK
| | - Sarah K Edwards
- Sexual Health Cambridgeshire Community Services, Cambridgeshire, UK
| | - Deepa Grover
- Barnet General Hospital, Hertfordshire, UK Royal Free Hospital, London, UK
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Liu C, Wang C, Glesby MJ, D’souza G, French A, Minkoff H, Maurer T, Karim R, Young M. Effects of highly active antiretroviral therapy and its adherence on herpes zoster incidence: a longitudinal cohort study. AIDS Res Ther 2013; 10:34. [PMID: 24373482 PMCID: PMC3904465 DOI: 10.1186/1742-6405-10-34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) is common among HIV-infected individuals, but the impacts of highly active antiretroviral therapy (HAART) and HAART adherence on HZ risk have not been well studied. METHODS The effects of HAART and HAART adherence on HZ incidence were evaluated by comparing HIV-infected women on HAART (HAART use group) with the HIV-infected women remaining HAART naïve (HAART naïve group) in the Women's Interagency HIV Study (WIHS). A 1:1 matching with propensity score for predicting HAART initiation was conducted to balance background covariates at index visit, including HIV disease stage. Kaplan-Meier method was used to compare the risk of HZ development between the matched pairs. Cox proportional hazard models were used to assess the effects of HAART and HAART adherence on HZ incidence. RESULTS Through propensity score matching, 389 pairs of participants were identified and they contributed 3,909 person years after matching. The background covariates were similar between the matched pairs at the index visit. The participants had a mean age around 39 years old, and about 61% of them were Black and 22% were Latina. No significant difference in HZ risk was observed between the HAART use group and the HAART naïve group during the first year of follow-up in any analyses. In the univariate analysis, the HAART use group had marginally lower HZ risk (Hazard Ratio (HR): 0.72; 95% Confidence Interval (CI): 0.48-1.1) over the entire follow-up period. However, women with a HAART adherence level of ≥95% had significantly lower HZ risk (HR: 0.54; 95% CI: 0.31, 0.94) compared to the HAART naïve women. The association remained significant after adjusting for quality of life score and acyclovir use, but it attenuated and was no longer statistically significant after adjusting for an intermediate variable, either CD4+ T cell counts or HIV viral load. CONCLUSIONS Among adult women, we observed a significant preventive effect of long-term HAART use on HZ incidence when a HAART adherence level of ≥95% was attained, and this effect was mediated through reduction of HIV viral load and improvement of CD4+ T cell counts.
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Affiliation(s)
- Chenglong Liu
- Department of Medicine, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA
| | - Cuiwei Wang
- Department of Medicine, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA
| | - Gypsyamber D’souza
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Audrey French
- Division of Infectious Diseases, Cook County Hospital, Chicago, lL, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Toby Maurer
- Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA
| | - Roksana Karim
- Departments of Pediatrics and Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary Young
- Department of Medicine, Georgetown University, 2115 Wisconsin Avenue NW, Suite 130, Washington, DC 20007, USA
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Moreno-Coutiño G, Arenas R, Reyes-Terán G. Improvement in onychomycosis after initiation of combined antiretroviral therapy. Int J Dermatol 2012; 52:311-3. [DOI: 10.1111/j.1365-4632.2011.05346.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Han J, Lun W, Meng Z, Huang K, Mao Y, Zhu W, Lian S. Mucocutaneous manifestations of HIV-infected patients in the era of HAART in Guangxi Zhuang Autonomous Region, China. J Eur Acad Dermatol Venereol 2012; 27:376-82. [DOI: 10.1111/j.1468-3083.2011.04429.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cedeno-Laurent F, Gómez-Flores M, Mendez N, Ancer-Rodríguez J, Bryant JL, Gaspari AA, Trujillo JR. New insights into HIV-1-primary skin disorders. J Int AIDS Soc 2011; 14:5. [PMID: 21261982 PMCID: PMC3037296 DOI: 10.1186/1758-2652-14-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 01/24/2011] [Indexed: 11/23/2022] Open
Abstract
Since the first reports of AIDS, skin involvement has become a burdensome stigma for seropositive patients and a challenging task for dermatologist and infectious disease specialists due to the severe and recalcitrant nature of the conditions. Dermatologic manifestations in AIDS patients act as markers of disease progression, a fact that enhances the importance of understanding their pathogenesis. Broadly, cutaneous disorders associated with HIV type-1 infection can be classified as primary and secondary. While the pathogenesis of secondary complications, such as opportunistic infections and skin tumours, is directly correlated with a decline in the CD4+ T cell count, the origin of the certain manifestations primarily associated with the retroviral infection itself still remains under investigation. The focus of this review is to highlight the immunological phenomena that occur in the skin of HIV-1-seropositive patients, which ultimately lead to skin disorders, such as seborrhoeic dermatitis, atopic dermatitis, psoriasis and eosinophilic folliculitis. Furthermore, we compile the latest data on how shifts in the cytokines milieu, impairments of the innate immune compartment, reactions to xenobiotics and autoimmunity are causative agents in HIV-1-driven skin diseases. Additionally, we provide a thorough analysis of the small animal models currently used to study HIV-1-associated skin complications, centering on transgenic rodent models, which unfortunately, have not been able to fully unveil the role of HIV-1 genes in the pathogenesis of their primarily associated dermatological manifestations.
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de Carvalho VO, Cruz CR, Noronha L, Abagge KT, Lima HC. An inflammatory reaction surrounding molluscum contagiosum as possible manifestation of immune reconstitution inflammatory syndrome in HIV infection. Pediatr Dermatol 2010; 27:631-4. [PMID: 21078110 DOI: 10.1111/j.1525-1470.2010.01322.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Highly active antiretroviral therapy can restore specific immune responses and control of microorganism infections in human immunodeficiency virus-positive patients. This immune recovery may cause an inflammatory reaction to microbial and autoimmune antigens known as immune reconstitution inflammatory syndrome. We describe a clinical case with an intense inflammatory response surrounding molluscum contagiosum after highly active antiretroviral therapy. The clinical and laboratory findings suggested that the reaction was due to immune reconstitution inflammatory syndrome occurring during a period of immune recovery in a child with acquired immune deficiency syndrome.
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Affiliation(s)
- Vânia Oliveira de Carvalho
- Division of Pediatric Dermatology, Department of Pediatrics, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.
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Meys R, Gotch FM, Bunker CB. Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution-associated disease? Br J Dermatol 2009; 162:6-11. [PMID: 19709102 DOI: 10.1111/j.1365-2133.2009.09365.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.
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Affiliation(s)
- R Meys
- Department of Dermatology, Chelsea and Westminster Hospital, Imperial College, 369 Fulham Rd, London SW10 9NH, UK
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Venkat A, Piontkowsky DM, Cooney RR, Srivastava AK, Suares GA, Heidelberger CP. Care of the HIV-Positive Patient in the Emergency Department in the Era of Highly Active Antiretroviral Therapy. Ann Emerg Med 2008; 52:274-85. [DOI: 10.1016/j.annemergmed.2008.01.324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 01/08/2008] [Accepted: 01/16/2008] [Indexed: 01/16/2023]
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Abstract
HIV patients develop a variety of infectious and non-infectious diseases of the skin and mucous membranes. Some of these serve as indicator diseases for a weakening immune system. While none of the dermatological complications is pathognomonic, conditions such as oral hairy leukoplakia, herpes zoster, thrush, and eosinophilic folliculitis should make physicians consider the possibility of underlying HIV disease. Moreover, one has to consider HIV if these skin diseases take an atypical or severe course, or if they do not respond properly to appropriate medication. Frequent and rare dermatoses occurring in HIV infection are discussed.
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Affiliation(s)
- U R Hengge
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf, Germany.
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Lehloenya R, Meintjes G. Dermatologic Manifestations of the Immune Reconstitution Inflammatory Syndrome. Dermatol Clin 2006; 24:549-70, vii. [PMID: 17010783 DOI: 10.1016/j.det.2006.06.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The immune reconstitution inflammatory syndrome (IRIS) represents a diverse range of immunopathologic reactions resulting in clinical deterioration that may occur as immune function is partially restored in HIV-infected patients receiving highly active antiretroviral therapy. Approximately half of IRIS events are dermatologic, and dermatologic IRIS is described in relation to a wide range of conditions, the commonest being herpes zoster and herpes simplex. Most cases of IRIS result in mild and moderate symptoms, but non-dermatologic manifestations related to IRIS have resulted in death. This article covers certain general issues related to IRIS and then focuses on the spectrum of dermatologic manifestations.
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Affiliation(s)
- Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, 7925, South Africa
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Zancanaro PCQ, McGirt LY, Mamelak AJ, Nguyen RHN, Martins CR. Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: An institutional urban clinic experience. J Am Acad Dermatol 2006; 54:581-8. [PMID: 16546578 DOI: 10.1016/j.jaad.2005.12.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 12/05/2005] [Accepted: 12/15/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Widespread introduction of highly active antiretroviral therapy (HAART) in the mid 1990s has altered the presentation of the cutaneous manifestations associated with HIV infection. OBJECTIVE Our purpose was to evaluate the use of HAART on the prevalence and spectrum of cutaneous manifestations in HIV-infected patients. METHODS A study of the initial visits of 897 HIV-infected patients at an urban dermatology clinic between 1996 and 2002 was performed. RESULTS Folliculitis was the most common cutaneous disorder identified. Patients with CD4-positive cell counts less than 200 cells/mm3 had an increased prevalence of folliculitis and prurigo nodularis, whereas those with HIV viral loads higher than 55,000 copies/mL had a higher prevalence of idiopathic pruritus and candidiasis. Patients not receiving HAART had increased rates of folliculitis and prurigo nodularis. Patients receiving HAART had increased rates of photosensitivity and molluscum contagiosum. LIMITATIONS This was a cross-sectional study in which temporality was unable to be determined. CONCLUSION With ongoing therapeutic advancements, the cutaneous manifestations associated with HIV infection will continue to evolve.
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Moyle M, Woolley IJ, Thevarajan I, Korman TM. Eosinophilic folliculitis: an example of 'immune reconstitution folliculitis'? AIDS 2004; 18:2350-2. [PMID: 15577558 DOI: 10.1097/00002030-200411190-00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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