Faculty Collaboration Database

Preoperative immune status determines anal condyloma recurrence after surgical excision. Dis Colon Rectum 2003 Mar;46(3):367-73

Date

03/11/2003

Pubmed ID

12626913

DOI

10.1007/s10350-004-6557-6

Scopus ID

2-s2.0-0037339180 (requires institutional sign-in at Scopus site)   36 Citations

Abstract

PURPOSE: Immunosuppression is an important risk factor for anal condyloma progression; however, its effects on postoperative outcomes remain unclear. In the present study, we investigated risk factors and recurrence rates in immunocompromised patients requiring surgery for medically intractable anal condyloma.

METHODS: A retrospective review was performed on 63 consecutive patients who underwent surgical intervention for medically intractable anal condyloma at a single institution. Patient cohorts included immunosuppressed patients (e.g, HIV-seropositive, leukemia, idiopathic lymphopenic syndrome, or transplant patients; n = 45) and immunocompetent patients (n = 18). Recurrence rates and time to recurrence after surgery were determined for both groups. Preoperative CD4 count and viral load within the HIV subpopulation were also determined. The majority of the patients were male (90 percent), with a median age of 36 years.

RESULTS: Anal condyloma recurred in 66 percent of the immunosuppressed patients compared with 27 percent of the immunocompetent group. Recurrence time expressed in months was shorter in immunosuppressed patients than in immunocompetent patients (6.8 +/- 1.5 vs. 15 +/- 5.7 months; P< 0.05). In the subpopulation of HIV-seropositive patients, no association was found between recurrence rates and viral loads; however, CD4 counts were significantly lower in those who had recurrence than in those who did not (226 +/- 31.7 vs. 401 +/- 51.2 cells/microl; P< 0.05).

CONCLUSIONS: After surgery, anal condyloma in immunosuppressed patients recurs significantly more often and within a shorter period of time than in patients with a competent immune system. Additionally, in HIV-seropositive patients, CD4 counts should be maximized to prevent early recurrence of anal condyloma.

Author List

de la Fuente SG, Ludwig KA, Mantyh CR

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Anus Diseases
CD4 Lymphocyte Count
Cohort Studies
Condylomata Acuminata
Endoscopy
Female
HIV Infections
Humans
Immunocompetence
Immunocompromised Host
Male
Middle Aged
Recurrence
Retrospective Studies
Risk Factors
Treatment Outcome
Viral Load