Objectives: To describe the incidence and risk factors for verrucae in HIV-infected and uninfected women.
Design and methods: A prospective study of 1790 HIV-infected and 772 uninfected women. Skin examinations and interviews were performed every 6 months over an 8-year study period. Data collected at each visit included antiretroviral therapy use since the prior visit, CD4 counts, HIV RNA loads, and location, description, and diagnosis of verrucae. Incidence rates of cutaneous and anogenital warts were determined.
Results: Unadjusted cumulative incidence of cutaneous warts for HIV-uninfected women was 6.6%, 6.7% for HIV-infected women who initiated HAART, and 8.4% for HIV-infected, HAART-naïve women. The unadjusted cumulative incidence of anogenital verrucae for HIV-uninfected women was 9.3%, 28.4% for HIV-infected women who initiated HAART, and 25.1% for HIV-infected women who were HAART-naïve. Multivariate proportional hazard models revealed the following significant factors for the development of cutaneous verrucae among HIV-infected women: Black race [relative hazard (RH) = 0.50] and Hispanic ethnicity (RH = 0.38), compared to White race. Risk factors for anogenital verrucae were: more recent recruitment (RH = 0.63), human papillomavirus infection at baseline (RH = 1.85), decade of age (RH = 0.82), current smoker (RH = 1.40), lowest CD4 count (per 100 cells/microl) in the past 4 years (RH = 0.85), and log10 higher HIV viral load at the prior visit (RH = 1.34).
Conclusion: HIV-infected women had a significantly increased cumulative incidence of anogenital verrucae compared to HIV-uninfected women. Although HAART did not alter the risk of developing skin or anogenital warts, those with higher CD4 cell counts and lower HIV RNA levels had a lower risk of developing anogenital warts.