Current status of antiviral therapy for juvenile-onset recurrent respiratory papillomatosis

Abstract

Human papillomavirus (HPV) infections are among the most prevalent of the sexually transmitted diseases, with up to 75% of women in the United States acquiring genital HPV infection at some point in their lives. HPV infections of the genital tract are of medical and public health concern due to their propensity to lead to the development of cervical cancer, and because they can be transmitted to the respiratory tract of a newborn child, resulting in juvenile-onset recurrent respiratory papillomatosis (JO-RRP). JO-RRP is the second most common cause of hoarseness among pediatric patients, and is the most common benign neoplasm in the larynx. The traditional treatment for JO-RRP is the physical removal of the wart through laryngoscopy and surgical debulking of the airway papillomas. Papillomas frequently recur following surgical resection, however, often necessitating repeated ablative efforts to maintain a patent airway. In a minority of patients, surgical management must be supplemented with adjuvant medical therapy, with interferon being the best studied and most commonly utilized. Recently, a Phase II investigation of a therapeutic vaccine yielded promising results, and a Phase III evaluation of this therapeutic modality is planned. Other adjuvant treatments currently being utilized, but for which controlled data of benefit are lacking, include cidofovir, indole-3-carbinol, ribavirin, mumps vaccine, and photodynamic therapy. As with surgical management, viral persistence occurs following treatment with these adjuvant modalities, further contributing to the challenge of managing patients with this potentially devastating disease.