Interferons in the treatment of human papillomavirus diseases

Clinical study with recombinant interferon gamma versus interferon alpha-2c in patients with condylomata acuminata

A multi-centre, randomized, open-label trial was conducted to evaluate the safety and efficacy of recombinant interferon (rIFN) alpha-2c versus rIFN gamma in patients with recurrent or persistent condylomata acuminata (CA). Thirty-three such patients were treated either with 6 micrograms rIFN alpha-2c or with 0.1 mg rIFN gamma (both equivalent to 2 x 10E6 IU), single dose, subcutaneously 3 times a week for 6 weeks. In case of no complete clearance at week 10, a second course of treatment with the other type of rIFN was given. There was no significant difference in the complete clearance proportions at week 10 between the two treatment groups (3/16 vs 6/17). No relapses occurred in these patients during the 16 weeks' follow-up. Further clearances during the follow-up resulted in a total complete clearance proportion of 14/33 at the end of study. The treatment was well tolerated. Repeated interferon therapy has its place in treating persistent or recurrent condylomas.

Systemic antiviral drugs used in ophthalmology

Over the past two decades, the recognition of viral enzymes and proteins that can serve as molecular targets of drugs has revolutionized the treatment of viral infections. Beginning with acyclovir, a number of systemically administered agents which are both relatively safe and effective for the treatment of herpetic infections and human immunodeficiency virus (HIV) infections have become widely available. Because of increased numbers of herpes virus infections, as well as the rising epidemic of HIV infections, the ophthalmologist is, more likely than ever before to be involved in the treatment of severe and frequent ocular infections caused by herpes viruses. In addition, the acute retinal necrosis (ARN) syndrome has been demonstrated to be caused by herpes viruses and a once rare retinal infection caused by cytomegalovirus is common in patients with the acquired immunodeficiency syndrome (AIDS). In this article, four systemic antiviral drugs (Vidarabine, Acyclovir, Ganciclovir, and Foscarnet) that have demonstrated usefulness in the treatment of ophthalmic disease are reviewed in detail with regard to their mechanisms, applications, effectiveness, and side effects.

Detection of human papillomavirus infection in diseased and nondiseased sites of the respiratory tract in recurrent respiratory papillomatosis patients by DNA hybridization

We examined 12 recurrent respiratory papillomatosis patients, who were undergoing treatment for recurrence of their disease, for the presence of human papillomavirus (HPV). Biopsies were obtained from their respiratory papillomas and nondiseased sites (NDS) of the respiratory tract: the nasopharynx, posterior tonsillar pillar, aryepiglottic fold, cervical trachea, intrathoracic trachea, and bronchi. The presence of HPV DNA was determined by using the ViraPap/ViraType DNA hybridization procedure. Two thirds of the patients were infected with HPV 6/11 in either the diseased papilloma or NDS: 50% of patients with papilloma specimens typed positive (6 of 12), and 40% of the patients typed HPV-positive in one or more biopsies from the NDS (4 of 10). No single NDS was more likely to be infected with HPV than any other. No oncogenic HPV types 16/18 or 31/33/35 were detected in the papillomas or NDS of these patients. Only patients with multiple, and not isolated, papilloma involvement were found to harbor HPV DNA in NDS; and 80% of those with infected NDS, compared to 20% of those without infected NDS, required a shorter (no more than 3 months) surgical treatment interval. Our results show that HPV infection frequently persists in adjacent, clinically normal sites, and suggest that the extent of NDS involvement may predict both the extent of disease and the likelihood of recurrence.

Systemic alpha-interferon (Wellferon) treatment of genital human papillomavirus (HPV) type 6, 11, 16, and 18 infections: double-blind, placebo-controlled trial

The efficacy of systemic interferon-alpha (IFN-alpha n1; Wellferon) treatment on genital human papillomavirus (HPV) infections was studied in a double-blind, placebo-controlled trial. A total of 120 women were randomly allocated to receive either interferon (IFN, n = 60) or placebo (n = 60). In both treatment groups, 15 patients with lesions induced by each of the four HPV types (HPV 6, 11, 16, and 18) were included. The dose of IFN was 1.5 x 10(6) IU subcutaneously three times for the first week followed by 3 x 10(6) IU three times weekly for a further 6 weeks. The control patients received matching placebo injections. Ten patients (three IFN-treated and seven placebo-treated) were lost to follow-up. As determined by colposcopy, cytological and histological examinations, and HPV typing (in situ hybridization, ISH), 8 IFN-treated patients (14%) and 11 placebo-treated patients (18%) showed complete response (CR) at the 8th week. The corresponding figures were 22 (37%) and 25 (43%) at the 24th week and 28 (49%) and 25 (49%) at the 52nd week, respectively. The total number of HPV DNA negative patients at Week 8 was 29 (49%) in the IFN group and 24 (40%) in the placebo group (statistically nonsignificant). At Week 24, 37 (63%) of the IFN-treated patients and 39 (67%) of the placebo-treated patients were HPV DNA negative. In 2 placebo-treated cases, cervical lesions progressed to CIN III and were treated by conization after the 24th week. There were 4 recurrences (7%) in the IFN group and no recurrences in the placebo group at the 24th week, corresponding figures at the 52nd week being 6 (11%) and 4 (7%), respectively. When the clinical efficacy was evaluated in relation to the histological grade of lesion and four different HPV types, there were no differences in CR or in the number of HPV DNA negative patients between the two study groups. In conclusion, systemic IFN-alpha therapy did not show any significant therapeutic effect on genital HPV infections (by HPV types 6, 11, 16, and 18) compared to placebo.

Topical treatment with human leukocyte interferon of HPV 16 infections associated with cervical and vaginal intraepithelial neoplasias

The present placebo-controlled, double-blind trial was designed to determine the effect of potent human leukocyte interferon cream (IFN) on genital HPV 16 (high-risk-type) infections associated with cervical intraepithelial neoplasia (CIN) and/or vaginal intraepithelial neoplasia (VAIN). Twenty women were treated with either IFN or placebo cream. The daily dose of IFN was 9 x 10(6) IU. The patients applied the cream deep into the vagina every night for 2-week courses 1 week apart. The entire treatment period was 12 months. On the basis of colposcopical, cytological, and histological examinations, 4 of 9 patients in the IFN group and 7 of 10 patients in the placebo group showed clinical remissions at the end of the trial. However, the virological studies gave a different picture. After treatment, 6 of 9 in the IFN group and 3 of 10 in the placebo group were HPV 16 DNA negative (in situ hybridization). All four patients in remission after IFN were HPV 16 DNA negative, whereas 4 of 7 patients in remission after placebo were still HPV 16 DNA positive. One patient treated with placebo showed progression; no patient in the IFN group showed progression. During the post-treatment follow-up of 16 months, no recurrences were noted in the IFN group, as compared with 2 of 10 in the placebo group. These results showed a marked discrepancy between clinical evaluation (colposcopy, Pap smear, biopsy) and virological findings. Further studies are needed to clarify the prognostic value of the different evaluation criteria. It is encouraging that the high-risk HPV 16 infection was eradicated in two-thirds of the patients treated with topical IFN.

Nucleic acid spot hybridization with nonradioactive labeled probes in screening for human papillomavirus DNA sequences

We examined 161 human tissue samples using the spot hybridization technique with nonradioactive labeled DNA probes of human papillomavirus (HPV). Whole cells were spotted on nitrocellulose filters; DNA of the cells was denatured and fixed to the filter. Then the DNA spots were hybridized to nonradioactive labeled DNA and monitored by a sandwich immunoenzymatic reaction. This technique is simple, sensitive, specific, requires no special equipment, and can be used in clinical settings. HPV DNA was found in 92% of samples in which, on the basis of histologic and colposcopic criteria, its presence was suspected, as well as in 31 samples where it was not suspected.