Combined therapy trial with interferon alpha-2a and ablative therapy in the treatment of anogenital warts.

OBJECTIVE: To determine whether the combination of systemically administered interferon alpha-2a and ablative surgery for the treatment of genital and/or perianal warts produces a 30% or greater improvement in lasting response rate compared with a control group receiving a combination of placebo and ablative therapy. DESIGN: Randomised, triple-blind, placebo-controlled trial using 1 or 3 MIU of interferon alpha-2a or placebo administered subcutaneously three times weekly for 10 weeks in combination with ablative surgery. SETTING: International, multicentre study in 10 genitourinary medicine clinics. PATIENTS: Two hundred and fifty patients with anogenital warts. MAIN OUTCOME MEASURES: Lasting response at week 38. RESULTS: Standard efficacy analysis at week 38 showed a lasting response in 51% (35/68) of 3 MIU interferon-treated patients, 48% (30/63) of 1 MIU interferon-treated patients and 43% (29/67) of placebo-treated patients. CONCLUSIONS: With the doses and regime described, treatment with interferon alpha-2a in combination with ablative therapy is not significantly superior in the treatment of anogenital warts than placebo and ablative therapy.

Immunohistochemical demonstration of papillomavirus infection in condylomatous and preneoplastic lesions of the lower female genital tract.

An immunoperoxidase study of 250 cases of condyloma of the female genital tract showed HPV expression in 45% of the cases. The flat form was the most frequent (191/250 cases). Condylomatous lesions were associated with dysplasia, in situ or micro-invasive carcinoma in 43% of the cases. The results support the role of the HPV as a possible carcinogenic agent in the female genital tract.

Immunoglobulin classes of antibody for human T-lymphotropic virus type-I (HTLV-I) in healthy donors and HTLV-I-associated disorders.

Healthy blood donors, patients with adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy (HAM) and recipients of unscreened blood (SR) who had seroconverted and were followed-up for more than 2 years were examined for HTLV-I antibodies of immunoglobulin G (IgG) and M(IgM) classes. The overall infection rate in donors was 4.9%, as determined by screening with a particle agglutination method (PA). The rate increased with increasing age. Positive sera with a low titer in the PA test (1/16, 1/32 and 1/64) contained IgM antibodies in 32.5% (titer 1/16) to 36.1% (titer 1/64) of the cases, but IgG antibodies were detected in only 5.6% of the sera with a titer of 1/16 and in 36.1% of the sera with a titer of 1/64. Conversely, in high titer sera (1/128 or higher) IgG antibodies were almost always detectable (99.0%) and IgM antibodies less frequently (25.5%). Sera from acute, chronic and pre-ATL, HAM and SR patients contained IgG antibodies in high titer in all cases. The incidence of IgM antibodies was 7.7, 30.0, 53.3, 72.3, and 77.8%, respectively. IgM antibodies were demonstrated repeatedly in some cases who were followed up for a year. Only IgM antibodies from HAM patients occurred in high titers and had strong reactivity to the p24 antigens of HTLV-I in Western blot testing. It is concluded that it is important to detect IgM antibodies not only in primary infections but also in persistent infections of HTLV-I.

A problemática dos condilomas atípicos do cérvix / The problem of atypical cervical condylomas

Com base em uma revisäo dos casos de condilomas cervicais estudados clinicamente, colpo-cito-histologicamente e mediante auto-radiografia e microscopia eletrônica, investigou-se o problema dos condilomas atípicos. Descrevem-se as últimas variedades de HPV descobertas, a relaçäo dos condilomas com as CIN e seu possível diagnóstico diferencial. Finalmente, destaca-se a importância do estudo das células de Langerhans e dos mercadores imunológicos para o diagnóstico dos condilomas atípicos