Human papillomavirus and immunosuppression.

Chronic immunosuppression for various reasons is an important risk factor for persistent infections with human papillomaviruses (HPV) and HPV-associated disease. Anogenital cancers and their precursor lesions play an important role in modern HIV medicine. Anal intraepithelial neoplasia and anal cancer are especially prevalent in HIV-positive men who have sex with men, and experts have advocated screening similarly to cervical cancer screening for this high-risk group. HPV-induced skin warts are a frequent problem of organ transplant recipients (OTRs) and a severe manifestation (generalized verrucosis) of certain primary immunodeficiencies. HIV-positive individuals are very often affected by genital warts (condylomata acuminata). Iatrogenic immunosuppression in OTRs allows more active replication of the commensal β-papillomavirus spectrum in the entire skin. A high viral DNA load in plucked eyebrow hairs was shown to imply a significant risk for the development of cutaneous squamous cell carcinoma. This may explain the up to 250-fold increased risk of OTRs to develop precancerous actinic keratoses and skin cancer.