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Federación Mexicana de Ginecología y Obstetricia, A.C.

2006, Number 06

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Ginecol Obstet Mex 2006; 74 (06)

Assessment of the treatment with imiquimod in persistent infection by human papillomavirus with the polimerase chain reaction method

Hernández QT, Illanes AB, Salas LN, Alarcón RLC, Hernández VM

Language: Spanish
References: 36
Page: 317-326
PDF size: 331.56 Kb.


ABSTRACT

Background: Molecular studies have shown that oncogenic genotypes of human papillomavirus (HPV) are the main risk factor for cervical cancer development. Sub-clinical wound does not cause symptoms and is diagnosed by colposcopy or histology, in addition the latent infection is associated with the presence of DNA of the HPV, but when clinical and histological abnormalities are not presented only molecular techniques can detect this infection.
Objective: To determine if complementary processing with imiquimod, recent medicament with powerful antiviral activity in vitro as in vivo, reduces the cervical persistence of HPV.
Patients and methods: This study was carried out with 87 patients, who had antecedents of HPV cervical and intraepithelial wound with low degree. Patients were divided as follows: treated with cryotherapy, cervical loop electrosurgical and imiquimod, all with diagnosis by cervical cytology, colposcopy and polymerase chain reaction (PCR) for HPV. At 3, 6 and 12 months after the processing, PCR, cervical cytology and colposcopy control were carried out again.
Results: Out of the 87 patients studied, 11% (10) patients treated with cervical cytology were positive for VPH; with colposcopy 8% (7) of patients and with PCR 40% (34) of patients; decreased persistence with combined methods of loop and imiquimod was obtained in 29% (5) patients; however, when utilized imiquimod alone, there were 55% (11) patients with persistence determined by PCR method.
Discussion: Imiquimod appears to be beneficial in 45% of the patients, in contrast with efficacy reported until 85% in genitals and annals warts, in addition, the capacity of eliminating the viruses has been shown, therefore it is possible that its potential effect could be observed long-time. It is evident that the percentages of viral detection are improved for PCR method, compared with indirect methods as cervical cytology and colposcopy, which is favorable when virus serotypes are of high degree of transformation and ablative methods should be conservatives due to fertility motives.


REFERENCES

  1. Bosch FX. Human papillomavirus in cervical cancer. Curr Oncol Rep 2002;4:175-83.

  2. Garfias CR, Peral CV, Azpilcueta AJ. Conceptos actuales sobre la infección por virus papiloma humano. Ginecol Obst Mex 1995;63:509-13.

  3. Conger KL, Liu JS, Kuo SR, Chow LT, Wang SF. Human papillomavirus DNA replication. J Biol Chem 1999;274:2696-705.

  4. Meyer T, Arndt R, Chistophers E, et al. Association of rare human papillomavirus types with genital premalignant and malignant lesions. J Infect Dis 1998;178:252-5.

  5. Zur Hausen H. Papillomavirus infections a major cause human cancers. Biochim Biophys Acta 1996;1288:55-78.

  6. Sisk E, Robertson ES. Clinical implication of human papillomavirus infection. Front Biosci 2002;7:77-84.

  7. Cox JT. Management of cervical intraepithelial neoplasia. Lancet 1999;353:857-9.

  8. Beutner KR. Patient-applied treatment for external genital warts: the time has come. West J Med 1998;169:288-97.

  9. Manos MM, Waldman J, Zhan TY, et al. Epidemiology and partial nucleotide sequence of four novel genital human papillomavirus. J Infect Dis 1994;180:1096-9.

  10. Shanta V, Krishnamurthi S, Gajalakshmi CK, Swaminathan R, Ravichandran K. Epidemiology of cancer of the cervix: global and national perspective. J Indian Med Assoc 2000;98:49-52.

  11. Berth-Jones J, Bourke J, Eglitis H, et al. Value of a second freeze-thaw cycle in cryotherapy of common warts. Br J Dermatol 1994;131:883-6.

  12. Chirenje ZM, Rusakaniko S, Akino V, Milingo M. A randomized clinical trial of loop electrosurgical excision procedure (LEEP) versus cryotherapy in the treatment of cervical intraepithelial neoplasia. J Obstetric Gynaecol 2001;21:617-21.

  13. Fraught W, Prevost MR, Fung MFK, Senterman M. The efficacy of loop electrosurgical excision procedure as compared to cold-knife cone biopsy in patients with unsatisfactory colposcopy. Eur J Gynaecol Oncol 1999;3:116-20.

  14. Kucera E, Sliutz G, Czerwenka K, et al. Is high-risk human papillomavirus infection associate with cervical intraepithelial neoplasia eliminated after conization by loop excision of transformation zone. Eur J Obst Gynecol Reprod Biol 2001;100:72-76.

  15. Thompson AD, Duggan MA, Nation J, Penny MA. Investigation of laser cervical cone biopsies negative for premalignancy or malignancy. J Lower Genital Tract Disease 2002;6:84-91.

  16. Tseng CJ, Lin CC, Huang CT, Chou KG, Chang TC. A study of diagnostic failure of loop conization in microinvasive carcinoma of the cervix. Gynecol Oncol 1999;73:91-95.

  17. Arany I, Tyring SK, Stanley MA, et al. Enhancement of the innate and cellular immune response in patients with genital warts treated with topical imiquimod cream 5%. Antiviral Res 1999;44:55-63.

  18. Beetheide W, Bernard HU, Tan YJ, et al. Potential drugs against cervical cancer: Zinc-ejecting inhibitors of the human papillomavirus type 16 E6 oncoprotein. J Natl Cancer Inst 1999;91:1211-20.

  19. Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV study Group. Arch Dermatol 1998;134:25-30.

  20. Phelps WC, Alexande KA. Antiviral therapy for human papillomaviruses: rational and prospects. Ann Intern Med 1995;123:368-72.

  21. Stanley M. Papillomavirus: biology and clinical implications for immunotherapy. Mol Med Today 1997;3:239-40.

  22. Tyring SK. Human papillomavirus infection: Epidemiology, pathogenesis, and host immune response. J Am Acad Dermatol 2000;43:18-30.

  23. Vardy DA, Baadsgaard O, Hansen Er, Lisby S, Vejilsgaard GL. The cellular immune response to human papillomavirus infection. Int J Dermatol 1990;29:603-10.

  24. Yliskoski M, Cantell K, Syrjanen K, Syrjanen S. Topical treatment with human leukocyte interferon of HPV 16 infections associated with cervical and vaginal intraepithelial neoplasia. Gynecol Oncol 1990;36:353-7.

  25. Arany I, Tyring SK, Brysk MM, et al. Correlation between pre-treatment levels of interferon response genes and clinical response to an immune response modifier (Imiquimod) in genital warts. Antimicrob Agents Chemother 2000;44:1869-73.

  26. Beutner KR, Spruance SL, Hougham AJ, et al. Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 1998;38:230-39.

  27. Dahl MV. Imiquimod: an immune response modifier. J Am Acad Dermatol 2000;43:1-5.

  28. Stockfleth E, Rowert J, Arndt R, Christophers E, Meyer T. Detection of human papillomavirus and response to topical 5% imiquimod in a case of stucco keratosis. Br J Dermatol 2000;143:846-50.

  29. Trindle RW, Frazer IH. Immunology and anogenital human papillomavirus (HPV) infection. Aust N Z J Obstet Gynaecol 1990;30:370-5.

  30. Golfarb MT, Gupta AK, Gupta MA, Sawchuk WS. Office therapy for human papillomavirus infection in nongenital sites. Dermatol Clin 1991;9:287-96.

  31. Jastreboff AM, Cymet T. Role of the human papillomavirus in the development of cervical intraepithelial neoplasia and malignancy. Postgrad Med J 2002;78:1-7.

  32. Mayrand ME, Coutlee F, Hankins C, et al. Detection of human papillomavirus type 16 DNA in consecutive genital samples does not always represent persistent infection as determined by molecular variant analysis. J Clin Microbiol 2000;38:3388-93.

  33. Rosseau MC, Franco EL, Villa LL, et al. A cumulative case-control study of risk factor profiles for oncogenic and nooncogenic cervical human papillomavirus infection. Cancer Epidemiol Biomarkers Prev 2000;9:469-76.

  34. Schiff M, Beckert TM, Masuk M, et al. Risk factor for cervical intraepithelial neoplasia in Southwestern American Indian Women. Am J Epidemiol 2000;152:716-726.

  35. Bernard HU, Chan SY, Manos MM, et al. Identification and assessment of known and novel human papillomavirus by polymerase amplification, restriction fragment length polymorphisms, nucleotide sequence, and phylogenetic algorithms. J Infection Diseases 1994;170:1077-85.

  36. Harnish DG, Belland LM, Sheid EE, Rohan TE. Evaluation of human papillomavirus consensus primers for HPV detection by polymerase chain reaction. Moll Cell Probes 1999;13:9-21.




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