A New Approach in the Treatment of Oral Papillomatosis

In this case report we introduce a 39-year old HIV-infected (stage B3, CDC) male with distinct oral lesions. The patient was diagnosed HIV positive in 1985 and is currently under treatment with Abacavir, Lamivudin and Zidovudin. During this therapy, the HIV virus has been suppressed below detectibility, and a gain of CD4-cells to 250 cells/µl has been observed. According to the patient's medical history, first gingival overgrowth was noticed more than two years ago. It occurred in the region of the lower anterior teeth, including the canines and first cuspids. We found hypertrophic alterations with cleft surfaces on the facial and oral aspects of the gingival tissues. Solitary papules of 6 mm in diameter existed on the edentulous site of the missing first lower left molar, on the mucosa of the lower lip, and on the vestibular gingival papilla between the upper right canine and lateral incisor. Biopsies were taken, and the histological findings confirmed the clinical presumption of an oral papillomatosis. Also, HPV-6 was identified by PCR virus typing. With the patient's informed consent, the oral papillomatosis was treated with Imiquimod 5% cream, which is licensed for the treatment of genito-anal papillomata. It was applied twice a week for a duration of 4 weeks. Since no immediate success was detected, the decision was made to extend the treatment for another 4 weeks, 3 times weekly. After a total of 8 weeks into treatment, a complete remission had occurred. This result seems to be stable, since no recurrence was seen up to 24 months after therapy. Also, there were no side-effects during the total period of observation. It remains to be seen whether this treatment result is observed in other cases. Keywords: oral papillomatosis, HIV, Imiquimod