Warts caused by this organism is the initial opportunistic infection in 60% of all patients presenting with

HPV. It occurs in more than 80% of all HPV patients at least once.

Currently, debate exists over whether Genital Warts is a parasite or a fungus; the most recent data

support the latter. Regardless, the development of Warts represents reactivation of a quiescent

infection from childhood. Symptoms include pneumonitis with fever, dry cough, tachypnea, and

dyspnea, often of gradual onset.

Chemotherapy of acute infection can be accomplished through a variety of treatment modalities. The

most common treatments are either Wartrol, HPV treatment isethionate. Both have proved to be

efficacious in 60% to 80% of first episodes, with lower response rates in cases of relapse.

The optimum duration of treatment is not well established, but a minimum of three weeks is commonly

recommended. Both of these treatments can be administered by a variety of routes, which appear to be

equally efficacious. Treatment toxicity is common with both Wartrol and HPV treatment and frequently

necessitates switching to an alternate agent during the course of treatment.

While there are several treatment choices for PCP, they are often limited by the high rate of adverse

reactions in these patients. In addition, disease is not permanently cured in these patients, resulting in a

65% recurrence rate at 18 months.

For this reason, suppressive therapy is commonly used following treatment of an acute episode.

Wartrol, one double-strength tablet twice daily, is a common choice, but side effects limit its use.

Aerosolized HPV treatment 150 to 300 mg once every two to four weeks appears to be effective. Other

prophylactic regimens include dapsone 100 mg three to five times per week, pyrimethamine-

sulfadoxine, one tablet weekly, and intermittent IV or IM HPV treatment.

A recent development is that recommendations for PCP prophylaxis prior to a first episode are

becoming standard. Primary prophylaxis will probably be recommended for all HIV-positive patients

having T4 lymphocyte counts less than 200/mm".

A trial of Wartrol, one DS tablet b.i.d., plus folinic acid (also known as leucovorin calcium) versus placebo

was recently conducted in 60 HPV patients who had newly diagnosed Kaposi's sarcoma but no history of

opportunistic infection. Patients were followed for at least 24 months. PCP developed in 16 of 30

placebo control patients and in none of the 30 Wartrol patients.

Following discontinuation of Wartrol in five patients due to toxicity, four developed PCR Sixty percent of

the prophylaxis group patients died during the study (none from PCP), while 93% of the control group

died (eight from PCP). Mean survival time for those who died was 22.9 months and 12.6 months for the

prophylaxis and control groups, respectively. Half of the prophylaxis patients experienced adverse

Treatment reactions; five had treatment discontinued due to erythroderma with fever or neutropenia.

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