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Naturally occurring, nonregressing canine oral papillomavirus infection: host immunity, virus characterization, and experimental infection.

Papillomaviruses occasionally cause severe, nonregressing or recurrent infections in their human and animal hosts. The mechanisms underlying these atypical infections are not known. Canine oral papillomavirus (COPV) typically regresses spontaneously and is an important model of mucosal human papillomavirus infections. A severe, naturally occurring, nonregressing COPV infection provided an opportunity to investigate some aspects of viral pathogenicity and host immunity. In this case, the papillomas proved refractory to surgical and medical treatments, including autogenous vaccination and vaccination with capsid (L1) virus-like particles. High levels of induced anti-L1 antibodies appeared to have no effect on the infection. The papillomas spread to oesophageal mucosa, perioral haired skin, and remote cutaneous sites. Isolation of COPV from the animal and sequencing of several regions of the viral genome showed no differences to the COPV prototype. Experimental infection of beagle dogs with this viral isolate resulted in the uncomplicated development and regression of oral warts within the usual period, indicating that the virus was not an unusual pathogenic variant. These findings support the hypothesis that the recurrent lesions seen in some human papillomavirus infections, such as recurrent laryngeal papillomatosis, are associated with specific defects in host immunity rather than variations in viral pathogenicity.

Animals↗

[Role of macrophages in papillomavirus infections].

Papillomaviruses have naturally a strict tropism to epithelial cells in which they replicate during the cell differentiation. There is no histological evidence of any inflammatory reaction. No leucocyte recruitment is observed and thus, the role of macrophages during the early infectious process in the epithelium remains unknown. This silent, subacute or chronic infectious disease is characterized fundamentally by a dual pathogenic process, including an infectious process leading to the production of infective virus particles during the differentiation of infected epithelial cells, on the one hand, and an oncogenic process due to interactions of viral oncogenes with host cell regulatory proteins after integration of the virus to the cellular genome. The role of activated macrophages on the oncogenic process is clearly established. They contribute to regulate negatively the transcription of the non structural E6 E7 viral oncogenes and have cytotoxic effects to transformed cells by a direct intercellular contact without evidence of an effect due to a soluble factor such as tumor-necrotizing factor (TNF). Macrophages have, hence, a prominent role as cellular effectors of protective immunity against lesions due to papillomaviruses and particularly against the oncogenic process complicating these infections.

Cytotoxicity, Immunologic↗

Intravenous cidofovir-induced resolution of disfiguring cutaneous human papillomavirus infection.

Human papillomavirus infection is one of the most common and most distressing cutaneous diseases in patients with HIV infection. It is also a common, and often therapeutically challenging, infection in individuals who are immunologically competent. A wide range of therapeutic options exists for treating cutaneous human papillomavirus infections, but none is uniformly effective. In this report we describe a man with HIV-1 infection and disfiguring facial verruca vulgaris who demonstrated complete clinical response to intravenous cidofovir. Our report provides further support for the use of intravenous cidofovir as therapy for treatment-resistant and/or widespread cutaneous human papillomavirus infection.

Adult↗

Genital human papillomavirus infections.

Human papillomavirus infections of the genitals are very widespread in the sexually active population throughout the world. Not only cosmetically unattractive skin warts but also genital squamous epithelial carcinomas of both sexes may be caused by human papillomavirus infections. In the past 30 years, this has led to intensive research on human papillomavirus. This paper reviews and evaluates the current literature on the pathomechanism, diagnostics, therapy, risk groups and clinical significance of human papillomavirus in urology and other specialties.

Female↗

Epidemiology of human papillomavirus infections.

Human papillomavirus infection represents the most common mucocutaneous viral infection, and 3% to 5% of all patients have clinically evident warts. Human papillomavirus infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. With the use of a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than is clinically apparent infection.

Adolescent↗

Clinical, histopathologic, and molecular aspects of cutaneous human papillomavirus infections.

Human papillomaviruses comprise a large family of double stranded DNA viruses that are the etiologic agents of benign warts and anogenital cancers. At least 82 different human papillomavirus types have been identified and many remain yet uncharacterized. The development of new molecular techniques in recent years has led to an increased understanding of human papillomaviruses and their roles in carcinogenesis. Several clinicopathologic entities arising from human papillomavirus infection encountered by the dermatologist are the subject of the article. The epidemiology, molecular biology, clinical presentation, histologic findings, and treatment of each disorder, where applicable, is discussed.

Condylomata Acuminata↗

Epidemiology and natural history of genital human papillomavirus infection.

Human papillomavirus (HPV) is a ubiquitous human pathogen that causes cervical and other anogenital cancers as well as genital warts and recurrent respiratory papillomatosis. Human papillomavirus infection is most common among young, sexually active individuals, and it is so prevalent that approximately 75% to 80% of sexually active individuals will become infected in their lifetime. Currently, options are limited for both prevention of infection of patients with HPV-associated disease: infection can only be prevented with complete abstinence from all forms of sexual activity because condoms do not offer complete protection from HPV and HPV can be transmitted by nonintromissive sexual activities. Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence. Soon, however, prevention of these HPV-related diseases may be available in the form of a prophylactic HPV vaccine. Phase 3 studies of a quadrivalent vaccine that protects against both high- and low-risk types of HPV demonstrated the vaccine to be 100% effective in preventing HPV type 16- and type 18-associated cervical disease, suggesting that these vaccines, if made widely available, will dramatically reduce the burden of HPV-related disease.

Condylomata Acuminata↗

Vaccines for the prevention of human papillomavirus infections.

Human papillomavirus (HPV) infection is the known cause of almost all cases of cervical cancer. An understanding of the HPV genome has allowed the development of two prophylactic vaccines capable of protecting against both persistent HPV infection and cervical intraepithelial neoplasia (CIN) with 100% efficacy in fully vaccinated women. The vaccines, manufactured by Merck (Gardasil, which was approved by the US FDA in June, 2006) and GlaxoSmithKline (Cervarix, which will be submitted for US FDA approval by the end of 2006), both target HPV types 16 and 18, which together account for 70% of cervical cancer. Merck vaccine also targets HPV 6 and 11, covering =90% of genital warts. These vaccines are highly immunogenic and have an excellent safety profile. HPV vaccines promise to offer an exciting contribution to healthcare and cancer prevention. However, many questions remain concerning who to vaccinate, the duration of protection, cost, public acceptance, and the potential for worldwide distribution.

Alphapapillomavirus↗

Genital human papillomavirus infections in the male sexual partners of 45 female patients with papillomavirus infection.

Forty-five women with a confirmed genital human papillomavirus (HPV) infection and their regular male sexual partners were examined. The diagnosis of the women was based on the colposcopic examination with cytological and histological samples. The men were studied by using a similar microscopic technique. Penisscopic and histological examinations showed that 22 out of the 45 men had genital HPV infection although only 7 men showed visible condylomatous warts. In addition, nine men had clinical lesions highly suggestive to HPV infection in penisscopy but they had unspecific histological samples. 23 of these 31 men were symptom-free. These results further emphasize the importance of regular examinations of the male sexual partners of women with genital HPV infection in order to prevent recurrences and spreading of the infection.

Adult↗

Control of interferon signaling in human papillomavirus infection.

Human papillomaviruses (HPV) infect mucosal and cutaneous epithelium resulting in several types of pathologies, most notably, cervical cancer. Persistent infection with sexually transmitted oncogenic HPV types represents the major risk factor for the development of cervical cancer. The development of HPV-associated cervical cancer has been closely linked to the expression of the viral oncogenes E6 and E7 in the tumor cells. The major viral oncoproteins, E6 and E7, target the cellular tumor suppressor gene products p53 and Rb, respectively. As detailed within, these interactions result in the stimulation of proliferation and the inhibition of apoptosis, thus representing major oncogenic insults to the infected cell. In addition to mediating transformation, the E6 and E7 genes also play significant roles in altering the immune response against infected cells by suppressing interferon (IFN) expression and signaling. At the clinical level, IFNs have been used in the treatment of HPV-associated cervical intraepithelial neoplasia (CIN) or cervical cancers with mixed results. The success of the treatment is largely dependent on the subtype of HPV and the immune response of the patients. Despite this inefficiency, the increasing knowledge about the regulation of IFN signaling pathways at molecular level may hold a promise for the use of new therapeutic strategies against HPV infection. Studies on the regulation of the function of IFN-inducible gene products by the E6 and E7 may lead to the development of new therapeutic approaches based on strategies that modify the function of the HPV oncoproteins and restore IFN-signaling pathways through endogenous control mechanisms.

Animals↗

Interferons in human papillomavirus infections.

Human papillomavirus (HPV) infections usually present as benign warts (e.g., condyloma acuminatum, CA) but can also be responsible for dysplasia and carcinoma. Therapeutic options include chemotherapeutic agents, cryotherapy and surgery, but all these treatments are anti-tumor, not anti-viral. Interferons (IFNs) are the only anti-viral drugs approved for the therapy of benign HPV-related lesions. While IFN-alpha, IFN-beta and IFN-gamma have all been tested against CA, most information is available on IFN-alpha which appears efficacious via a number of routes of administration, schedules and dosages with an acceptable safety profile. The highest rate of success with IFN-alpha therapy, in terms of reduced recurrence rates of CA was reported from studies in which all visible lesions were surgically removed with subsequent administration of subcutaneous local IFN-alpha. Less data is available on the efficacy of IFNs in the treatment of HPV-related dysplasia and carcinoma, but combination therapy (e.g., IFN-alpha plus retinoids for cervical carcinoma) appears promising. Future advances in control of HPV-related lesions are expected to continue to involve IFN combined with non-antiviral therapies as well as the use of exogenous inducers of IFNs and other cytokines.

Clinical Trials as Topic↗

Human papillomavirus infection.

The human papillomavirus, well known as the etiologic agent of warts, has recently received much attention in the medical literature for its association with various cancers. This article discusses the virology, epidemiology, pathogenesis, immunology, clinical manifestations, and therapy for human papillomavirus infection. Some newer techniques for identifying human papillomavirus in tissue, based on recent advances in molecular biology, are also covered. Two final topics addressed are human papillomavirus infection in the immunocompromised host, including patients with acquired immunodeficiency syndrome, and the possible role of human papillomavirus in several different carcinomas.

Adolescent↗

[Virologic diagnosis of papillomavirus infections].

Human papillomavirus are strictly epitheliotropic and host-specific. Currently, 57 different types based on deoxyribonucleic acid sequence rather than serology have been identified. Some papillomavirus types infect the skin, while others infect the oral or genital mucous membranes. Human Papillomavirus type 16 is often associated with invasive carcinomas of the uterine cervix and of their intra-epithelial precursors. Recent data on viral pathogenesis suggest that the protein encoded by the E7 gene of human papillomavirus type 16 is able to bind to the retinoblastoma and p53 gene products. If various techniques for the detection of human papillomavirus may be used (cytology, electron microscopy and immunocytochemistry), as will become apparent, nucleic acid hybridization is the most reliable method for viral diagnosis and genotyping.

Humans↗

Genital human papillomavirus infection.

Human papillomavirus is one of the most common causes of sexually transmitted diseases. In the past ten years, 60 different types of papillomavirus have been identified. Although the virus often causes asymptomatic genital infection, it has been strongly associated with lower genital tract carcinoma; therefore, its detection and eradication are important. All patients with evidence of human papillomavirus infection should undergo colposcopy and, depending on the extent of infection and the type of histology, should receive definitive treatment.

Female↗

The development of cervical cancer and its precursors: what is the role of human papillomavirus infection?

Human papillomavirus (HPV) is a significant health care burden in the United States. The majority of sexually active men and women will be infected with HPV at some point in their lives and are subject to developing human papillomavirus-associated disease. Current estimates suggest that 20 million Americans are currently infected, and more than 5 million new infections occur each year. The prevalence of human papillomavirus is highest in populations in their late teens and early twenties, with nearly half of all new human papillomavirus infections occurring within 3 years of first intercourse. HPV is the necessary cause of genital warts, cervical intraepithelial neoplasia, and invasive cervical cancer. As such, human papillomavirus is responsible for significant medical morbidity and health care costs. Screening with cervical cytology has significantly reduced mortality rates; however, approximately 3900 women will die in 2005 from cervical cancer in the United States. Human papillomavirus DNA testing has shown promise in identifying high-grade abnormalities as an adjunct to traditional cytology, and should be used according to guidelines established by the American Cancer Society and the American College of Obstetricians and Gynecologists. The epidemiology of HPV infection and a brief introduction to the natural history of HPV infection will be presented here.

Adolescent↗

Inter-laboratory variation as an explanation for varying prevalence estimates of human papillomavirus infection.

Human papillomavirus (HPV) infection has been strongly implicated as a cause of genital neoplasia. Although Southern blot DNA hybridization techniques are regarded as the most accurate means of identifying HPV infection, studies using this technique to measure infection have provided varying estimates of the prevalence of HPV among healthy and diseased groups. This investigation provides a possible explanation for study-to-study differences, by demonstrating inter-laboratory variability in the detection and typing of HPV by Southern blot. Four experienced laboratories tested 40 identical, masked samples of DNA extracted from presumed infected and non-infected tissues. The pairwise percentage agreement between the laboratories in judging samples as HPV-positive or negative ranged from 66 to 97%. Among samples judged to contain HPV, agreement as to type ranged from 77 to 96%. We conclude that inter-laboratory differences are an important consideration in any discussion of HPV prevalence estimates.

Analysis of Variance↗