Photogallery. Human papillomavirus infection of the skin and mucous membranes in people living with HIV

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The human papillomavirus is ubiquitous. It is estimated that over a third of people with apparently healthy skin are carriers of human papillomavirus. HIV-associated immunodeficiency contributes to the manifestation of clinical symptoms of human papillomavirus infection. Against the background of severe (the number of CD4+ T-lymphocytes below 200 cells/μl) and pronounced (CD4+ T-lymphocytes from 200 to 349 cells/μl) immunodeficiency caused by HIV infection (human immunodeficiency virus), the period of persistence of human papillomavirus is longer, and the clinical picture and course of human papillomavirus infection can significantly differ compared to HIV-positive individuals with intact immunity and people without HIV. At the same time, formations on the skin and mucous membranes are often multiple and can be characterized by rapid growth, large size, location outside the typical localization, resistance to treatment, recurrent course, and lack of tendency to spontaneous regression. Taking antiretroviral drugs for the treatment of HIV infection has a generally beneficial effect on the clinical course and prognosis of viral warts; With regard to anogenital warts, the researchers’ conclusions are not so clear. A number of experts believe that viral-immunological control of HIV infection may not be sufficient to successfully combat venereal warts.

The photogallery presents various clinical types of viral and anogenital (venereal) warts in people living with HIV. Each of them is assigned one of the variants of the stage of secondary diseases of HIV infection (4A, 4B or 4V according to its Russian clinical classification) depending on the severity of concomitant opportunistic diseases. In all clinical cases, with the exception of the last one, patients experienced severe or pronounced immunodeficiency and progression of HIV infection in the absence of antiretroviral therapy. In the last observation, giant Buschke–Levenstein condyloma developed with a slight immunodeficiency against the background of effective antiretroviral therapy.

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作者简介

Sergey Prozherin

Sverdlovsk Regional Center for Prevention and Control of AIDS

编辑信件的主要联系方式.
Email: progsherin@mail.ru
ORCID iD: 0000-0001-9956-4700
SPIN 代码: 5354-4893
俄罗斯联邦, Ekaterinburg

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2. Fig. 1. Patient M., 40 years old. Multiple vulgar (common) warts of the hand. On the dorsal (a) and palmar (b) surfaces of the hand there are numerous gray-brown papules ranging in size from 0.5 to 1.5 cm, rising above the level of the surrounding skin, with a bumpy and fissured surface consisting of papillomatous growths with hyperkeratosis. Some of the formations on the fingers merge with each other, forming extensive lesions.

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3. Fig. 2. Patient A., 41 years old. Flat warts. Around the mouth and on the anterolateral surface of the neck (a) there are numerous brownish-brown papules of a round and polygonal shape with a flat surface, up to 0.6 cm in diameter. On the dorsum of the hand (b) there are multiple flesh-colored flat papules.

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4. Fig. 3. Patient O., 36 years old. Vulgar warts. On the skin of the palmar surface of the hand there are numerous dense hemispherical formations of flesh color with a bumpy surface up to 0.8 cm in diameter; on the second finger there is a giant wart with pronounced hyperkeratosis, covering 2/3 palmar his surface.

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5. Fig. 4. Patient K., 31 years old. Plantar warts. In the area of the forefoot there are so-called «mosaic warts» in the form of a diffuse focus of yellowish-brown hyperkeratosis, along the periphery — small, similar in appearance, round formations.

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6. Fig. 5. Patient L., 35 years old. Vulgar warts. On the extensor surface of the elbow joint there are four irregularly rounded formations with a diameter of 0.5 to 1 cm, rising above the level of the surrounding skin, physiological coloring, with a bumpy surface, dense-elastic consistency. This case clearly demonstrates that with immunodeficiency, viral warts can be located on any part of the skin.

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7. Fig. 6. Patient S., 19 years old. Focal epithelial hyperplasia (Heck disease). On the red border of the lips (a) with a transition to the oral mucosa (b) there are pale pink dome-shaped papules up to 0.5 cm in size. When examined using the polymerase chain reaction method, human papillomavirus type 32 was detected from the surface of the papules.

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8. Fig. 7. Patient G., 35 years old. Anogenital warts (condyloma acuminata). On the head of the penis and the inner leave of the foreskin there are multiple formations of various sizes of pink and whitish color with a villous, tuberous surface. On the inner leave of the foreskin, condylomas merge with each other and look like “cauliflower”.

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9. Fig. 8. Patient D., 46 years old. Anogenital warts: giant Buschke–Lowenstein condyloma (a), condylomas acuminata (a, b), warts in the form of papules (b). Giant exophytic lesions with lobular division, a bumpy surface, predominantly pink in color, on a broad base in the pubic area and on the scrotum. Numerous pink formations with a villous, tuberous surface, merging with each other on the inner leave of the foreskin and the head of the penis. Large wart-like formations with a lobular structure and exophytic lesions of smaller sizes without finger-like protrusions on the surface of the skin of the buttocks and perianal area.

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10. Fig. 9. Patient P., 35 years old. Anogenital warts (giant condyloma Buschke–Lowenstein and condyloma acuminata). In the perianal area there are two foci of exophytic growths with a lobular structure, a tuberous surface, and pink color. One lesion is 6×3.5 cm in size and the other is 1×2 cm.

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11. Fig. 10. Patient S., 40 years old. Anogenital warts (giant Buschke–Lowenstein condyloma). In the area of the external genitalia, perineum and on the inner surface of the left thigh, there are exophytic growths with a bumpy surface, merging with each other, stagnant-red in color with a whitish coating on the surface. Around the lesions, manifestations of intertriginous dermatitis are observed in the form of erythema, maceration, slight infiltration of the skin. Concomitant condition: HIV infection. Stage of secondary diseases (4B) in remission during antiretroviral therapy. The level of CD4+ T-lymphocytes is 550 cells/μl.

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