Understanding Acquired Epidermodysplasia Verruciformis in Young People Living with HIV in Zimbabwe (360G-Wellcome-345726_Z_26_Z)

Perinatally-acquired HIV results in early-life immune dysregulation. Historically this led to high mortality rates in childhood. Following the widespread availability of antiretroviral therapy (ART), increasing numbers of people with perinatally-acquired HIV survive into adulthood. Despite effective viral suppression with ART, immune system abnormalities persist, predisposing individuals to a range of comorbidities. One such condition is acquired epidermodysplasia verruciformis (aEV), a disorder characterised by disseminated cutaneous infection with beta human papillomaviruses (HPV). While beta-HPVs are ubiquitous and typically asymptomatic in immunocompetent individuals, some people with HIV can develop extensive and persistent flat warts and pityriasis versicolor-like lesions (aEV). Where the association with HIV is recognised, aEV is highly stigmatising. The associated HPV types, particularly HPV 5 and 8, are potentially oncogenic and there are emerging cases of skin cancer in young people with aEV. There are currently no clear diagnostic criteria and the epidemiology, risk factors, virological drivers, and quality of life impact of aEV in this population remain poorly understood. People with aEV are offered minimal information or support to help them navigate their condition. This study seeks to address these gaps. The findings will inform future research directions, guide clinical management strategies, and support the development of targeted interventions.