Oral warts are becoming more common in HIV-positive individuals in the era of HAART, according to a study by Emory University School of Medicine published this week in Clinical Infectious Diseases. The findings confirm a study published last year by the Oral AIDS Center at University of California (San Francisco).
Oral warts were seen in five patients out of 2194 receiving care in Atlanta’s Oral Health Center in 1997, compared with 21 in 1999, whilst the San Francisco group reported that patients receiving HAART were six times more likely to have oral warts compared to those who did not receive HAART. The prevalence of warts in patients with HAART was just over 23% in the period 1996-1999 in the San Francisco clinic.
Although a temporal association with HAART was seen, the Atlanta group did not find clear evidence that wart emergence is associated with immune reconstitution. Similarly, they found that while risk of warts was associated with a viral load reduction of more than 1 log within the previous six months, there was no difference between patients with warts and those without in CD4 cell count changes prior to diagnosis with oral warts.
The Atlanta group speculates that immune reconstitution in the form of increased numbers of antigen presenting cells in the oral mucosa may trigger greater recognition of human papilloma virus, the agent which causes oral warts.
They also found a relationship between hepatitis B antibodies and the development of oral warts, leading the authors to suggest that sexual practices might be associated with an increased risk of oral infection with the agent which causes oral warts.
“The oral warts we see in HIV-positive individuals, including those on HAART, present substantial management challenges. The warts are often substantial and progressive, and recur after removal” said Deborah Greenspan of the University of California Oral AIDS Center.
Greenspan D et al. Effect of highly active antiretroviral therapy on frequency of oral warts. The Lancet 357: 1411-12, 2001.
King MD et al. Human papillomavirus-associated oral warts among human immunodeficiency virus-seropositive patients in the era of Highly Active Antiretroviral Therapy: an emerging infection. Clinical Infectious Diseases 34 (online edition), 2002.