Effectiveness and safety of tuberculin purified protein derivative for the treatment of anogenital warts in patients with human immunodeficiency virus
https://doi.org/10.4081/dr.2024.9754
Accepted: 30 August 2023
HTML: 4
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Individuals with human immunodeficiency virus (HIV) infection are prone to developing persistent and unremitting anogenital warts (AGWs). To address this health condition, immunotherapy using tuberculin purified protein derivative (PPD) has been proven to be a promising novel and safe treatment for AGWs in HIV patients. Therefore, this study involved a case of a 21-year-old man with stage I HIV infection, possessing CD4 counts 548 cells/uL and routinely receiving HIV antiretroviral. Patients presented with a condyloma acuminata type AGWs, supported by histopathological results, and tested positive for Human papillomavirus type 11. The treatment approach involved administering 15 tuberculin units of PPD weekly to the largest lesion for 5 weeks. The lesion started to respond two weeks following the first injection and showed a 50% decrease in size after five weeks. There was pain on the site of injection and sub-febrile for a short period. In conclusion, tuberculin PPD is safe and has the potential for the treatment of AGWs in HIV-positive patients for further development.
Gilson R, Nugent D, Werner RN, et al. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2020;34:1644-53.
Chikandiwa A, Pisa PT, et al. Incidence, persistence, clearance, and correlates of genital human papillomavirus infection and anogenital warts in a cohort of men living with human immunodeficiency virus in south africa. Sex Transm Dis. 2019;46:347-53.
Aldahan AS, Mlacker S, Shah VV, et al. Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature. Dermatol Ther. 2016; 29:197-207.
Mehta KS, Chauhan PS, Chandel M, et al. Evaluation of efficacy and safety of intradermal ppd for treating facial warts - a prospective study. IJCED-IP. 2019;5:322-6
Pahal P, Pollard EJ, Sharma S. PPD Skin Test. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556037/.
Achdiat PA, Antariksa NC, Rowawi R, et al. Success of intralesional purified protein derivative immunotherapy in the treatment of anogenital warts: A case report. J Exp Pharmacol. 2022;14:131-5.
Suwarsa O, Achdiat PA, Rowawi R, et al. Effect of Purified Protein Derivative Therapy on Serum Interleukin-12 Levels in Anogenital Warts Patients. Media Dermato Venereologica Indonesiana. 2022;49:190-219.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021; 70:1-187.
Hidalgo-Tenorio C, Gil-Anguita C, López Ruz MA, et al. ART is key to clearing oncogenic HPV genotypes (HR-LPV) in anal mucosa of HIV-positive MSM. PLoS One. 2019;14:e0224183.
Ankad B, Koti V. Dermoscopic assessment of periungual and genital warts treated by multiple modalities: A report. Int J Res Dermatol. 2022;8:415-8.
Winer RL, Koutsky LA. Genital human papillomavirus infection. In: Holmes HK, Sparling PF, Stamm WE, Piot P, et al., editors. Sexually transmitted diseases. 4th Ed. United States of America: McGraw Hill; 2008.
Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J. 2016;7:364-70.
Shaheen MA, Salem SA, Fouad DA, El-Fatah AA. Intralesional tuberculin (PPD versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2015;28:194-200.
Azab M, El-Shabrawy MM, Nafea EROA, Nada HA. Measurement of serum interleukin 17 level in patients with genital warts before and after intralesional tuberculin injection. J Mens Health. 2022;18:14.
Achdiat PA, Suwarsa O, Hidayat YM, et al. Succesful treatment of anogenital warts with single dose Bacillus Calmette Guerin vaccine without prior sensitization in tuberculosis endemic country: Two case report. Hum Vaccin Immunother. 2023;19:2187591.
Biofarma. Tuberculin PPD RT 23 SSI (2 TU). [Updated 2017 Nov 13]. Downloaded 2023 August 13. Available from: https://www.biofarma.co.id/en/latest-news/detail/tuberculin-ppd-rt-23-ssi-2-tu.
Saoji V, Lade NR, Gadegone R, Bhat A. Immunotherapy using purified protein derivative in the treatment of warts: An open uncontrolled trial. Indian J Dermatol Venereol Leprol. 2016;82:42-6.
Shaheen MA, Salem SA, Fouad DA, El-Fatah AA. Intralesional tuberculin (ppd) versus measles, mumps, rubella (mmr) vaccine in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2015;28:194-200.
Aboutaleb D, Abou-Taleb H, El-Badawy O, et al. Intralesional vitamin D3 versus intralesional purified protein derivative (PPD) in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2019;32:e13034.
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
