Evaluation of soluble CD4 serum levels in patients with anogenital warts treated with intralesional tuberculin injection

Abstract

Background: Anogenital warts are growths caused by human papilloma virus infection, which causes significant psychosocial morbidity. Intralesional immunotherapy is a promising treatment that is able to stimulate a delayed-type hypersensitivity reaction to different antigens as well as wart tissue. This treatment is suggested to increase CD4 T helper 1 lymphocyte activity to destroy human papilloma virus. Objective: To measure the level of serum soluble CD4 (sCD4) in patients with anogenital after intralesional tuberculin purified protein derivative (PPD) injection. Patients and Methods: This study was carried out as a pre–post interventional study on 49 patients with anogenital warts presented to the dermatology clinic and the andrology clinic, Suez Canal University Hospital. Each patient was injected 10U (0.2ml) of PPD intralesionally in the largest or mother wart with 2-week interval till complete cure or six injections, whichever was closer. Serum sCD4 was measured before and after injection using sandwich ELISA technique. Results: Complete clinical wart recovery was obtained in 26 (53%) patients and mostly was after the sixth session (60.4%) of injection. Mean level of serum sCD4 was significantly higher after than before PPD injection (18.47±10.4 vs. 44.48±20.67ng/ml, respectively). Serum sCD4 levels were significantly correlated to clinical response rates, as the higher the level of serum sCD4, the more the wart recovery. Conclusion: Intralesional PPD injection is a promising effective modality in the treatment of anogenital warts. CD4 cells may have a role in anogenital wart eradication by PPD injection and significantly related to clinical response rates.