Anogenital papillomavirus infection and neoplasia in immunodeficient women

People with deficient cell-mediated immunity have an increased susceptibility to viral infections and certain cancers, particularly large cell lymphomas and cancers of the skin and anogenital region. All are linked to viral origins. Neoplasms in the immunodeficient patient often occur at a relatively young age, involve multifocal locations, tend to persist, recur, and progress rapidly. Anogenital neoplasms show a strong association with HPV infection and also persist, extend, and progress, in spite of standard therapy. Since standard therapy of anogenital HPV infection and neoplasia is often not effective in immunodeficient patients (and others with an anogenital neoplastic syndrome), special treatment is required. 5-Fluorouracil chemosurgery, followed by maintenance 5-fluorouracil therapy, is effective and provides field suppression against recurrent HPV infection and neoplasia, with minimal damage to affected organs. After removal of all detectable HPV infection or neoplastic lesions, immunodeficient patients require close surveillance of the entire anogenital tract. Immunodeficient patients are an in-vivo human laboratory in which to study the natural history of HPV and its oncogenic effects on the anogenital tract. The theory of HPV oncogenesis is supported by the evidence gathered from these patients.