Paediatric Anogenital Condylomata Acuminata: An assessment of patient characteristics and the need for surgical
Alice Rose Langham1, Tarryn Gabler2, Catterina Bebington3
1Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Children with anogenital warts (AGCA) caused by Human Papilloma Virus (HPV) who are also Human Immunodeficiency Virus (HIV) positive require more surgical interventions for clearance. This highlights a significant difference in management needs for pediatric AGCA patients with HIV.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Anogenital Condylomata Acuminata (AGCA) are common manifestations of Human Papilloma Virus (HPV) infection.
- AGCA is frequently observed in children, particularly those who are immunocompromised, yet data on transmission, viral types, and management in this demographic is limited.
- This study investigated the characteristics of pediatric patients with AGCA, focusing on the impact of Human Immunodeficiency Virus (HIV) co-infection.
Purpose of the Study:
- To evaluate the clinical profile of pediatric patients presenting with anogenital warts (AGCA).
- To assess the correlation between HIV status and the management of AGCA in children.
- To determine if HIV-positive pediatric patients with AGCA require different treatment interventions compared to HIV-negative patients.
Main Methods:
- A retrospective review of patient records from January 2017 to December 2019 at Chris Hani Baragwanath Academic Hospital.
- Data collected included patient demographics, treatment details, surgical interventions, and HIV status.
- Statistical analysis using Fisher's and Pearson's tests was employed to correlate immune status with the need for surgical interventions.
Main Results:
- Sixty-six pediatric patients with AGCA were treated, with an average age of 4 years.
- Among the 30 patients with recorded HIV status, 15 were positive and 15 were negative.
- While the proportion of patients needing surgery was similar, HIV-positive children required significantly more surgical interventions for complete clearance (p=0.03).
Conclusions:
- Pediatric patients with AGCA who are co-infected with HIV necessitate a greater number of surgical procedures for treatment compared to their HIV-negative counterparts.
- Further research is warranted to identify specific HPV subtypes in this population and their potential impact on malignancy risk.
- Investigating earlier surgical intervention protocols for HIV-positive children with AGCA is recommended.
Background:
Anogenital Condylomata Acuminata (AGCA) are caused by Human Papilloma Virus (HPV), which is one of the most common sexually transmitted illnesses in adults. Although commonly seen in the paediatric population, especially in the setting of immunocompromise, literature regarding transmission, viral type and management in this population is scant. The aim of this study was to assess the profile of patients presenting with anogenital warts in light of associated immunocompromise with Human Immunodeficiency Virus (HIV).
Methods:
Three years of patient records from Chis Hani Baragwanath Academic Hospital were reviewed (January 2017 - December 2019). Information collected included: gender, age of presentation, age at intervention, type and duration of medical treatment, type and number of surgical interventions, HIV status, and histology results. Fisher's and Pearson's test were used to assess correlation between immune status and surgical interventions necessary.
Results:
In the time frame considered, we treated 66 patients with AGCA . The average age was 4 years old (1-14). HIV status was recorded in 30 patients (15 positive and 15 negative). Only one patient out of 66 had a history of sexual abuse. Whilst the proportion of patients who required surgical intervention in the HIV negative and HIV positive groups was equal (2:1), the total number of surgical interventions needed to achieve clearance was significantly more in those with HIV (p = 0.03).
Conclusions:
HIV positive patients with AGCA require more surgical interventions compared to HIV negative individuals. Further research will be conducted to ascertain the sub-type of HPV infection in this subset of patients and to assess if this impacts follow-up for future malignancy. Further research also needs to be conducted to ascertain whether surgical intervention should be instituted earlier in the treatment protocol for HIV positive children.
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