John H Lee1, Richard J Smith. 1. Department of Otolaryngology-Head and Neck Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA. john-h-lee@uiowa.edu
Abstract
PURPOSE OF REVIEW: Recurrent respiratory papillomatosis remains a serious disease and is commonly treated by otolaryngologists. The goals of this review are to update physicians on current understandings regarding viral pathogenesis, patient risks, and current trends in treatment strategies. RECENT FINDINGS: Surgical debulking still remains the foundation of treatment; however, newer surgical approaches utilizing microdebriders are replacing laser ablation. Genetic studies have identified individuals with specific immune cell alleles to be at greater risk for persistent infection. Our understanding of the viral pathogenesis has increased by the identification of a viral mechanism to downregulate antigen expression in cells infected with human papillomavirus, thus possibly allowing decreased immune detection. Although the viral types responsible for recurrent respiratory papillomatosis have been identified, the mechanism by which they alter cellular growth has not been identified. Research studies investigating adjuvant medical therapies aimed at reducing required surgical therapy intervals and possibly helping cure the infection are being completed. A safe, effective adjuvant therapy is still currently not available. SUMMARY: Improved surgical approaches have slightly enhanced patient care; however, more research is needed to understand how human papillomavirus causes disease so that these therapies can be developed.
PURPOSE OF REVIEW: Recurrent respiratory papillomatosis remains a serious disease and is commonly treated by otolaryngologists. The goals of this review are to update physicians on current understandings regarding viral pathogenesis, patient risks, and current trends in treatment strategies. RECENT FINDINGS: Surgical debulking still remains the foundation of treatment; however, newer surgical approaches utilizing microdebriders are replacing laser ablation. Genetic studies have identified individuals with specific immune cell alleles to be at greater risk for persistent infection. Our understanding of the viral pathogenesis has increased by the identification of a viral mechanism to downregulate antigen expression in cells infected with human papillomavirus, thus possibly allowing decreased immune detection. Although the viral types responsible for recurrent respiratory papillomatosis have been identified, the mechanism by which they alter cellular growth has not been identified. Research studies investigating adjuvant medical therapies aimed at reducing required surgical therapy intervals and possibly helping cure the infection are being completed. A safe, effective adjuvant therapy is still currently not available. SUMMARY: Improved surgical approaches have slightly enhanced patient care; however, more research is needed to understand how human papillomavirus causes disease so that these therapies can be developed.
Authors: Christopher B Buck; Cynthia D Thompson; Jeffrey N Roberts; Martin Müller; Douglas R Lowy; John T Schiller Journal: PLoS Pathog Date: 2006-07 Impact factor: 6.823