A 45-year-old male with progressive biphasic stridor since childhood, now exacerbating, undergoes laryngoscopy showing warty growths at bilateral vocal cords. Biopsy confirms recurrent respiratory papillomatosis (RRP). The causative HPV serotypes and current adjuvant therapy used after surgical debulking are:
- A HPV 6 and 11; intralesional cidofovir or bevacizumab (off-label) ✓
- B HPV 16 and 18; cisplatin-based chemotherapy
- C HPV 31 and 33; systemic interferon-alpha
- D HPV 6 and 11; oral acyclovir long-term
Explanation
Recurrent respiratory papillomatosis is caused predominantly by HPV serotypes 6 and 11, with HPV 11 associated with more aggressive disease and rare malignant transformation. Vertical transmission during vaginal delivery is the route in juvenile-onset RRP. Surgery (microdebrider or CO2 laser) remains the mainstay but does not cure. Current adjuvant therapies include intralesional cidofovir (a nucleoside analog inhibiting viral DNA polymerase), intralesional bevacizumab (anti-VEGF, reducing vascularity of papillomas), and in select cases, systemic bevacizumab. HPV 16 and 18 cause squamous cell carcinomas (high-risk), not RRP. Acyclovir is inactive against HPV.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.