Effectiveness and safety of tuberculin purified protein derivative for the treatment of anogenital warts in patients with human immunodeficiency virus


Submitted: 22 May 2023
Accepted: 30 August 2023
Published: 30 January 2024
Abstract Views: 118
PDF: 63
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Authors

  • Pati Aji Achdiat Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung; Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. https://orcid.org/0000-0002-3010-5052
  • Stephanie Widjaja Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. https://orcid.org/0009-0002-8817-1287
  • Oki Suwarsa Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Reiva Farah Dwiyana Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. https://orcid.org/0000-0001-9350-0239
  • Reti Hindritiani Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Endang Sutedja Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Hendra Gunawan Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Hermin Aminah Usman Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Fathia Rianty Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
  • Retno Hesty Maharani Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. https://orcid.org/0000-0002-4483-3552

Individuals with human immunodeficiency virus (HIV) infection are prone to developing persistent and unremitting anogenital warts (AGWs). To address this health condition, immunotherapy using tuberculin purified protein derivative (PPD) has been proven to be a promising novel and safe treatment for AGWs in HIV patients. Therefore, this study involved a case of a 21-year-old man with stage I HIV infection, possessing CD4 counts 548 cells/uL and routinely receiving HIV antiretroviral. Patients presented with a condyloma acuminata type AGWs, supported by histopathological results, and tested positive for Human papillomavirus type 11. The treatment approach involved administering 15 tuberculin units of PPD weekly to the largest lesion for 5 weeks. The lesion started to respond two weeks following the first injection and showed a 50% decrease in size after five weeks. There was pain on the site of injection and sub-febrile for a short period. In conclusion, tuberculin PPD is safe and has the potential for the treatment of AGWs in HIV-positive patients for further development.


Gilson R, Nugent D, Werner RN, et al. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2020;34:1644-53. DOI: https://doi.org/10.1111/jdv.16522

Chikandiwa A, Pisa PT, et al. Incidence, persistence, clearance, and correlates of genital human papillomavirus infection and anogenital warts in a cohort of men living with human immunodeficiency virus in south africa. Sex Transm Dis. 2019;46:347-53. DOI: https://doi.org/10.1097/OLQ.0000000000000979

Aldahan AS, Mlacker S, Shah VV, et al. Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature. Dermatol Ther. 2016; 29:197-207. DOI: https://doi.org/10.1111/dth.12352

Mehta KS, Chauhan PS, Chandel M, et al. Evaluation of efficacy and safety of intradermal ppd for treating facial warts - a prospective study. IJCED-IP. 2019;5:322-6 DOI: https://doi.org/10.18231/j.ijced.2019.067

Pahal P, Pollard EJ, Sharma S. PPD Skin Test. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556037/.

Achdiat PA, Antariksa NC, Rowawi R, et al. Success of intralesional purified protein derivative immunotherapy in the treatment of anogenital warts: A case report. J Exp Pharmacol. 2022;14:131-5. DOI: https://doi.org/10.2147/JEP.S347241

Suwarsa O, Achdiat PA, Rowawi R, et al. Effect of Purified Protein Derivative Therapy on Serum Interleukin-12 Levels in Anogenital Warts Patients. Media Dermato Venereologica Indonesiana. 2022; 49: 190-219.

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021; 70:1-187. DOI: https://doi.org/10.15585/mmwr.rr7004a1

Hidalgo-Tenorio C, Gil-Anguita C, López Ruz MA, et al. ART is key to clearing oncogenic HPV genotypes (HR-LPV) in anal mucosa of HIV-positive MSM. PLoS One. 2019; 14: e0224183. DOI: https://doi.org/10.1371/journal.pone.0224183

Ankad B, Koti V. Dermoscopic assessment of periungual and genital warts treated by multiple modalities: A report. Int J Res Dermatol. 2022; 8: 415-8. DOI: https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20221640

Winer RL, Koutsky LA. Genital human papillomavirus infection. In: Holmes HK, Sparling PF, Stamm WE, Piot P, et al., editors. Sexually transmitted diseases. 4th Ed. United States of America: McGraw Hill; 2008.

Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J. 2016; 7: 364-70. DOI: https://doi.org/10.4103/2229-5178.190487

Shaheen MA, Salem SA, Fouad DA, El-Fatah AA. Intralesional tuberculin (PPD versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2015;28:194-200.

Azab M, El-Shabrawy MM, Nafea EROA, Nada HA. Measurement of serum interleukin 17 level in patients with genital warts before and after intralesional tuberculin injection. J Mens Health. 2022; 18: 14.

Achdiat PA, Suwarsa O, Hidayat YM, et al. Succesful treatment of anogenital warts with single dose Bacillus Calmette Guerin vaccine without prior sensitization in tuberculosis endemic country: Two case report. Hum Vaccin Immunother. 2023; 19: 2187591. DOI: https://doi.org/10.1080/21645515.2023.2187591

Biofarma. Tuberculin PPD RT 23 SSI (2 TU). [Updated 2017 Nov 13]. Downloaded 2023 August 13 Available from: https://www.biofarma.co.id/en/latest-news/detail/tuberculin-ppd-rt-23-ssi-2-tu.

Saoji V, Lade NR, Gadegone R, Bhat A. Immunotherapy using purified protein derivative in the treatment of warts: An open uncontrolled trial. Indian J Dermatol Venereol Leprol. 2016; 82: 42-6. DOI: https://doi.org/10.4103/0378-6323.171650

Shaheen MA, Salem SA, Fouad DA, El-Fatah AA. Intralesional tuberculin (ppd) versus measles, mumps, rubella (mmr) vaccine in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2015; 28:194-200. DOI: https://doi.org/10.1111/dth.12230

Aboutaleb D, Abou-Taleb H, El-Badawy O, et al. Intralesional vitamin D3 versus intralesional purified protein derivative (PPD) in treatment of multiple warts: A comparative clinical and immunological study. Dermatol Ther. 2019; 32: e13034. DOI: https://doi.org/10.1111/dth.13034

Achdiat, P. A., Widjaja, S., Suwarsa, O., Dwiyana, R. F., Hindritiani, R., Sutedja, E., Gunawan, H., Usman, H. A., Rianty, F., & Maharani, R. H. (2024). Effectiveness and safety of tuberculin purified protein derivative for the treatment of anogenital warts in patients with human immunodeficiency virus. Dermatology Reports. https://doi.org/10.4081/dr.2024.9754

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