HPV Wart Persistence HIV — SCE Infectious Diseases MCQ

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EasyHIV MedicineHPV Wart Persistence HIVSCE Infectious Diseases

A 35-year-old man with HIV on ART (CD4 580, VL <50) develops a persistent verruca (plantar wart) that has been present for 2 years despite multiple courses of cryotherapy and salicylic acid. It is caused by HPV. Does HIV affect wart clearance?

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Correct answer: D — Yes — HPV clearance is impaired in PLWH even with well-controlled HIV; warts are more common, more persistent, and more treatment-resistant in HIV; continue treatment but manage expectations

HPV clearance is impaired in PLWH due to residual immune dysfunction even with suppressed VL and recovered CD4. Warts in HIV are: more numerous, more widespread, more resistant to treatment, and more likely to recur. Management: standard wart treatments (cryotherapy, salicylic acid, Imiquimod 5% cream, Podophyllotoxin) with the understanding that multiple treatments and longer courses are often needed. HPV vaccination (Gardasil 9) should be offered to prevent new type-specific infections. For refractory warts, specialist dermatology referral for: intralesional Bleomycin, photodynamic therapy, or laser ablation.

Reference: BHIVA 2022 – Dermatology; BAD 2023 – Warts; NICE CKS