Genital human papillomavirus infection and associated penile intraepithelial neoplasia in males infected with the human immunodeficiency virus

OBJECTIVE: To investigate the association between human papillomavirus (HPV) infections and penile intraepithelial neoplasia (PIN) in genital lesions from human immunodeficiency virus (HIV)+ men. For comparison, we also investigated the same association using specimens from HIV- men. STUDY DESIGN: Imprint smears from penile lesions were obtained from 70 men (mean age, 30 years) who visited a dermatologist. Thirty of them were known to be HIV seropositive. Two study groups were formed: one of 40 HIV- and another of 30 HIV+ males. The smears were examined cytologically for HPV identification or PIN, immunocytochemically for HPV detection and by in situ hybridization for HPV typing. RESULTS: The rates of detecting HPV infection cytologically were higher among men with HIV infection (50%) than among their HIV-seronegative counterparts (30%). There was immunocytochemical evidence of HPV in HIV-infected men in a greater proportion (50%) than in HIV noninfected men (37.5%). By in situ hybridization it was found that there was a higher prevalence of potentially oncogenic HPV (16/18, 31/33/35): 75% in moderate or severe dysplasia (PIN 2 and 3) and 66.6% in HIV+ men as compared with HIV- men (10-16.6%). CONCLUSION: HIV-seropositive males showed an unbalanced distribution of HPV, with a predominance of "high-risk" HPV types. This suggests that immunodepression encourages infection by this oncogenic virus, thereby contributing to the frequency of precancerous lesions in HIV+ men.