ESCMID - Transplant virology – Lausanne - 15 HPV in transplant Titrerecipients © by author ESCMID Online Lecture Library Olivier Gaide, MA, MD-PhD Dermatologie et Vénéréologie Human Papilloma VirusIntroduction • Group 1: ds DNA virus • Papillomaviridae • Non-envelloped • Circular DNA of 8kb • 8 proteins © by author • 6 early = viral replication ESCMID• 2 late = structural prot. Online Lecture Library 8kb of malevolence © by author ESCMID Online Lecture Library 8kb of malevolence © by author ESCMID Online Lecture Library Comes in > 170 flavors Disease HPV type Common warts 2, 7, 22 Plantar warts 1, 2, 4, 63 Flat warts 3, 10, 8 Anogenital warts 6, 11, 42, 44 and others Anal dysplasia (lesions) 6, 16, 18, 31, 53, 58 Highest risk: 16, 18, 31, 45 Genital cancers Other high-risk: 33, 35, 39, 51, 52, 56, 58, 59 Probably high-risk: 26, 53, 66, 68, 73, 82 Epidermodysplasia verruciformis© bymore authorthan 15 types Focal epithelial hyperplasia (oral) 13, 32 OralESCMID papillomas Online6, 7, Lecture 11, 16, 32 Library Oropharyngeal cancer 16 Laryngeal papillomatosis 6, 11 How to prevent it © by author ESCMID Online Lecture Library Prevention Disease HPV type Common warts 2, 7, 22 Plantar warts 1, 2, 4, 63 Flat warts 3, 10, 8 Anogenital warts 6, 11, 42, 44 and others Anal dysplasia (lesions) 6, 16, 18, 31, 53, 58 Highest risk: 16, 18, 31, 45 Genital cancers Other high-risk: 33, 35, 39, 51, 52, 56, 58, 59 Probably high-risk: 26, 53, 66, 68, 73, 82 Epidermodysplasia verruciformis© bymore authorthan 15 types Focal epithelial hyperplasia (oral) 13, 32 OralESCMID papillomas Online6, 7, Lecture 11, 16, 32 Library Oropharyngeal cancer 16 Laryngeal papillomatosis 6, 11 Prevention, larger than it may seem © by author ESCMID Online Lecture Library How to treat it • ---- Immuno-therapy Variable • Cryo-therapy Destruction 30% • Laser Destruction 50% • Condylin Immuno-therapy 70% © by author • Imiquimod Immuno-therapy 70% •ESCMIDBleomycine OnlineChemo-therapy Lecture Library 80% When to fear it ! © by author ESCMID Online Lecture Library Difficult cases • Nail warts © by author ESCMID Online Lecture Library Difficult cases • Nail warts • Old warts © by author ESCMID Online Lecture Library Difficult cases • Nail warts • Old warts • Mismatches © by author ESCMID Online Lecture Library Difficult cases • Nail warts • Old warts • Mismatches • Immune suppr. • Transplant R. © by author • HIV ESCMID• LLC Online Lecture Library Is it safe to use Imiquimod in OTR patients ? © by author ESCMID Online Lecture Library Seems safe enough © by author ESCMID Online Lecture Library But is it efficient ? Harder Not harder Eminence based… Eminence based Makes sense --- Stockfleth, pc Evidence based© by authorEvidence based HPV in HIVp studies AK co Renal Tr. ESCMID Online Lecture Library When to fear it ! © by author ESCMID Online Lecture Library What to fear ! • Hidden lesions © by author ESCMID Online Lecture Library What to fear ! • Hidden lesions • Wrong diagnosis © by author ESCMID Online Lecture Library What to fear ! • Hidden lesions • Wrong diagnosis • Ignorance © by author ESCMID Online Lecture Library What to fear ! • Hidden lesions • Wrong diagnosis • Ignorance © by author ESCMID Online Lecture Library What to fear !Arial • Hidden lesions • Wrong diagnosis • Ignorance © by author ESCMID Online Lecture Library Effects des mTORi on SCC in OTR patients © by author ESCMID Online Lecture Library Indication for a switch CNI - mTORi © by author ESCMID Online Lecture Library Take home messages Vaccinate your kids Vaccinate your transplant-reciptient patients Challenge each and every wart diagnosis Treat HPV-induced© carcinomaby author very aggressively ESCMIDConsider Online mTORi switch Lecture early (SCC Library pat.) Thank you ! .