Doświadczenia własne w leczeniu kłykcin kończystych odbytu u pacjentów z obniżoną odpornością w przebiegu zakażenia HIV i zespołu AIDS – obserwacja 18 przypadków

*Paweł Święcki¹, Małgorzata Kołodziejczak², Ewa Firląg-Burkacka¹, Andrzej Horban¹, Jacek Bierca²

Streszczenie
Perianal warts are caused by human papilloma virus (HPV) infection. Homo/bisexual contacts, drugs and diseases that impair immunity, smoking, oral contarceptives all are considered as risk factors of infection with human papilloma virus. HIV-positive patients with perianal warts may create special therapeutical problems.
This paper presents 18 HIV-positive patients (2 woman, 16 men), who have undergone surgical treatment for anorectal warts. Both women and 2 men had also genital warts. One man had giant warts (Buschke-Lowenstein tumor). In time of surgery most patients had relatively high CD4 lymphocytes count however, 12 of 18 patients have met CDC criteria for diagnosis of AIDS.
In all patients classical surgical technique of operation with electrocoagulation was used. Patient with giant warts was treated with cefotaxime and metronidazole, Six patients were treated with Augmentin, other patients were not treated with antibiotics. Postoperative course was uncomplicated in all patients. Histopathological examination of patient with Buschke-Lowenstein tumor revealed neoplastic transformation and patient was referred for consultation and further treatment to Institute of Oncology. In 5 cases (28%) recurrence was observed during several months to over one year of follow-up.
Conclusions. 1. Surgical excision of anorectal warts in patients with advanced HIV/AIDS gives good therapeutical effect 2. In HIV-positive patients the healing process after excision of anorectal warts is not different from seronegative patients, as long as surgery is performed at relatively high CD4 level. 3. Due to high incidence of warts located in anal canal it is recommended that all patients should be consulted by proctologist prior to surgery to perform rectoscopy and rule out laesions in anus. 4. Good relations between surgeon and specialist in infectious diseases is mandatory for successful treatment.

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