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Human Papilloma Virus Type 69 Identified in a Clinically Aggressive Plantar Verruca from an HIV-positive Patient

Jeffrey M. Whitaker, DPM ^*, Joel M. Palefsky, MD , Maria Da Costa, MS , Christy M. King, BA , James S. Johnston, BS  and Peter Barbosa, PhD 

^* California College of Podiatric Medicine, San Francisco, CA.
Department of Medicine, University of California at San Francisco, San Francisco, CA.
California School of Podiatric Medicine at Samuel Merritt College, Oakland, CA.

Corresponding author: Peter Barbosa, PhD, California School of Podiatric Medicine at Samuel Merritt College, 450 30th St, Ste 3716, Oakland, CA 94609. (E-mail: pbarbosa{at}samuelmerritt.edu)

Abstract

Background: Verrucae are caused by infection of epidermal keratinocytes by human papilloma virus (HPV). Although there are currently more than 100 known types of HPV, certain lesions are consistently caused by infection with one or a few types. Recent studies have identified the presence of unusual HPV types in anogenital and cervical condylomata (warts) of patients infected with human immunodeficiency virus (HIV). Although cutaneous verrucae are typically caused by HPV-1, HPV-2, and HPV-4, infection with HIV may predispose an individual to infection with an unusual HPV type.

Methods: We report the detection of a rare HPV type in a clinically aggressive plantar verruca from an HIV-positive patient. The viral DNA from this specimen was analyzed to identify the predominant HPV type. To complete this analysis, HPV DNA was extracted from the formalin-fixed specimen, followed by polymerase chain reaction with consensus HPV primers and digestion with a specific group of restriction endonucleases. The fragments were separated on an agarose gel, and the restriction fragment length polymorphism pattern was compared with known patterns for identification of the specific HPV type.

Results: Identification of HPV-69, an HPV type previously reported to be rare and associated with dysplastic lesions, was confirmed by HPV DNA dot-blot hybridization with specific DNA probes for each known HPV type.

Conclusions: Plantar verrucae in HIV-positive patients may be associated with unusual HPV types and should be analyzed and treated aggressively given the potential for a more distinct clinical manifestation. Additional lesional analysis studies are needed. (J Am Podiatr Med Assoc 99(1): 8–12, 2009)