CLINICAL AND IMMUNOLOGICAL APPROACHES TO THE TREATMENT OF RECURRENT GENITAL PAPILLOMAVIRUS INFECTION ASSOCIATED WITH HPV OF LOW ONCOGENIC TYPES
N.V. Shperling, I.A. Sperling
For quotation:
Shperling N.V., Shperling I.A. Clinical and immunological approaches to the treatment of recurrent human papillomavirus infection of the genitals associated with low-oncogenic HPV
types. Questions of practical colposcopy. Genital infections. 2023; (1): 58–66.
DOI 10.46393/27826392_2023_1_58
Annotation:
Purpose of the study: to update the main directions of interferon therapy for genital papillomavirus infection (PVI), associated with the human papillomavirus (HPV) of low-oncogenic types (6th or 11th), to expand the range of effective treatment methods for this disease available for clinical practice.
Material and methods. For eight years, post-registration observations of the effectiveness of interferon drugs (IFN) and IFN inducers in women and men aged 18–56 years (more than 400 people in total) with genital PVI associated with HPV types 6 or 11 were carried out in outpatient settings. who consented to participate in the study. As part of the observation, options for improving therapy were developed taking into account the immunological, cytokine status and clinical effectiveness of therapy. All patients were randomly assigned to groups according to the nature of the infection: asymptomatic HPV carriage, first clinical episode of PVI, recurrent PVI. The treatment program used drugs with registered indications and recommended doses for clinical use: a combination drug containing IFN-α-2b, taurine and benzocaine; meglumine acridone acetate and
Tilorone is a low molecular weight IFN inducer. During treatment and dynamic observation, clinical and laboratory studies were carried out: general examination with assessment of foci of condylomatous lesions, detection of tissues for the presence of HPV using the polymerase chain reaction (PCR), determination of indicators of cellular and humoral immunity in the blood, parameters of cytokine status (blood level α -, β- and γ-IFN, IL-2, IL-10, TNF-α). The severity of PVI symptoms was assessed using the original author's scoring system, which included subjective and objective signs of the disease. The frequency of observation was 5, 10, 40 days, 3, 6 months and 1 year after the start of treatment.
Results. Six laboratory criteria for assessing the effectiveness of treatment for PVI of the genitals and the risk of relapse have been developed: 1 – in the treatment of asymptomatic HPV carriage and newly diagnosed condylomas, a decrease in the blood level of CD8 lymphocytes and normalization of the number of CD16 lymphocytes indicate the effectiveness of therapy and the low likelihood of manifestation or relapse of infection; 2 – in the recurrent form of PVI, effective therapy is accompanied by an increase in the blood level of CD3, CD4 and CD16 lymphocytes in the absence of changes in the initially elevated level of CD8 cells, which reflects immune activation; 3 – with asymptomatic carriage of HPV, newly diagnosed condylomas and their recurrence, a decrease in the blood concentration of CD16 lymphocytes below normal indicates a risk of manifestation or recurrence of PVI; 4 – the ineffectiveness of interferon therapy in asymptomatic HPV carriage is evidenced by the absence of dynamics in the initially elevated blood levels of IL-2 and IL-10,
indicating persistent dyscytokinemia in the ratio of the activity of Th1 and Th2 cellular response; 5 – the ineffectiveness of interferon therapy for newly diagnosed condylomatosis is indicated by a decrease in the blood level of γ-IFN, IL-2 below normal and an increase in the level of TNF-α; 6 – the lack of effect of interferon therapy for recurrent genital condylomatosis is indicated by an increase in the blood level of IL-10 (predominance of the Th2 immune response). Schemes of differentiated interferon therapy for PVI of the genitals associated with HPV types 6 or 11 have been developed, taking into account the mono- and combined use of IFN drugs, IFN inducers and clinical and immunological types of the disease (asymptomatic carriage of HPV, the first clinical episode of PVI, recurrent course PVI).
Conclusion. The use of IFN drugs and IFN inducers for the treatment of genital PVI associated with HPV types 6 or 11 can increase the effectiveness of treatment. The IFN drug exhibits a pronounced clinical effect in the initial stages of treatment due to the relief of symptoms of a local inflammatory reaction. IFN inducers do not have a significant effect on the course of the post-destructive period, but in most cases they prevent the development or reduce the frequency of relapses of infection.
Journal “Issues of practical colposcopy. Genital infections" No. 1_2023
https://drive.google.com/file/d/137JZhJmdppROCPcjVUYpIBpS7lp-6CyZ/view
N.V. Shperling, I.A. Sperling
For quotation:
Shperling N.V., Shperling I.A. Clinical and immunological approaches to the treatment of recurrent human papillomavirus infection of the genitals associated with low-oncogenic HPV
types. Questions of practical colposcopy. Genital infections. 2023; (1): 58–66.
DOI 10.46393/27826392_2023_1_58
Annotation:
Purpose of the study: to update the main directions of interferon therapy for genital papillomavirus infection (PVI), associated with the human papillomavirus (HPV) of low-oncogenic types (6th or 11th), to expand the range of effective treatment methods for this disease available for clinical practice.
Material and methods. For eight years, post-registration observations of the effectiveness of interferon drugs (IFN) and IFN inducers in women and men aged 18–56 years (more than 400 people in total) with genital PVI associated with HPV types 6 or 11 were carried out in outpatient settings. who consented to participate in the study. As part of the observation, options for improving therapy were developed taking into account the immunological, cytokine status and clinical effectiveness of therapy. All patients were randomly assigned to groups according to the nature of the infection: asymptomatic HPV carriage, first clinical episode of PVI, recurrent PVI. The treatment program used drugs with registered indications and recommended doses for clinical use: a combination drug containing IFN-α-2b, taurine and benzocaine; meglumine acridone acetate and
Tilorone is a low molecular weight IFN inducer. During treatment and dynamic observation, clinical and laboratory studies were carried out: general examination with assessment of foci of condylomatous lesions, detection of tissues for the presence of HPV using the polymerase chain reaction (PCR), determination of indicators of cellular and humoral immunity in the blood, parameters of cytokine status (blood level α -, β- and γ-IFN, IL-2, IL-10, TNF-α). The severity of PVI symptoms was assessed using the original author's scoring system, which included subjective and objective signs of the disease. The frequency of observation was 5, 10, 40 days, 3, 6 months and 1 year after the start of treatment.
Results. Six laboratory criteria for assessing the effectiveness of treatment for PVI of the genitals and the risk of relapse have been developed: 1 – in the treatment of asymptomatic HPV carriage and newly diagnosed condylomas, a decrease in the blood level of CD8 lymphocytes and normalization of the number of CD16 lymphocytes indicate the effectiveness of therapy and the low likelihood of manifestation or relapse of infection; 2 – in the recurrent form of PVI, effective therapy is accompanied by an increase in the blood level of CD3, CD4 and CD16 lymphocytes in the absence of changes in the initially elevated level of CD8 cells, which reflects immune activation; 3 – with asymptomatic carriage of HPV, newly diagnosed condylomas and their recurrence, a decrease in the blood concentration of CD16 lymphocytes below normal indicates a risk of manifestation or recurrence of PVI; 4 – the ineffectiveness of interferon therapy in asymptomatic HPV carriage is evidenced by the absence of dynamics in the initially elevated blood levels of IL-2 and IL-10,
indicating persistent dyscytokinemia in the ratio of the activity of Th1 and Th2 cellular response; 5 – the ineffectiveness of interferon therapy for newly diagnosed condylomatosis is indicated by a decrease in the blood level of γ-IFN, IL-2 below normal and an increase in the level of TNF-α; 6 – the lack of effect of interferon therapy for recurrent genital condylomatosis is indicated by an increase in the blood level of IL-10 (predominance of the Th2 immune response). Schemes of differentiated interferon therapy for PVI of the genitals associated with HPV types 6 or 11 have been developed, taking into account the mono- and combined use of IFN drugs, IFN inducers and clinical and immunological types of the disease (asymptomatic carriage of HPV, the first clinical episode of PVI, recurrent course PVI).
Conclusion. The use of IFN drugs and IFN inducers for the treatment of genital PVI associated with HPV types 6 or 11 can increase the effectiveness of treatment. The IFN drug exhibits a pronounced clinical effect in the initial stages of treatment due to the relief of symptoms of a local inflammatory reaction. IFN inducers do not have a significant effect on the course of the post-destructive period, but in most cases they prevent the development or reduce the frequency of relapses of infection.
Journal “Issues of practical colposcopy. Genital infections" No. 1_2023
https://drive.google.com/file/d/137JZhJmdppROCPcjVUYpIBpS7lp-6CyZ/view
