Health Talk: Human papillomavirus

Dede Koswara, an Indonesian man, had been nicknamed “Treeman” for a large portion of his life. At first glance, any hints of normal pairs of arms, hands, legs, and feet were nonexistent — they had been covered by 13 pounds of a massive, thick structure that resembled the color and texture of curved tree roots and bark more than they resembled anything human. As reported in an article in The Sun, Koswara was not in pain but was unable to move his hands — his former life as a fisherman was eventually replaced by that of a freak show performer.

Despite his condition, Koswara was hopeful that doctors would be able to find a cure, and eventually they did — doctors discovered that Dede had a rare form of a human papillomavirus, or HPV, an infection of the skin. Human papillomavirus infections are caused by a papillomavirus, a virus that can enter the body through cuts and other small wounds, called microtraumas. Due to the mechanism with which the virus replicates, it can only infect body surface tissues, such as the skin or the outer layers of the mouth. Once inside the body, the virus replicates its DNA in host cells, after which causes the host cell to die, releasing more virus material. The process is then repeated, multiplying the number of viruses quickly.

HPV may be commonly thought of as a sexually transmitted infection, but this is not necessarily the case. There are over one hundred types of human papillomaviruses that have been identified, which are classified numerically. Different types infect specific parts of the body, causing specific reactions. Some are benign and asymptomatic while others can cause warts; certain types of HPV can even cause cancer. There are proteins in the body that usually function to suppress tumor formation, but the cancer-causing papillomaviruses have the ability to inactivate these.

While HPV would be the cause of Koswara’s warts, there is an underlying genetic reason as to why his condition spun out of control.
Koswara has a recessive genetic disorder known as epidermodysplasia verruciformis, which is characterized in part by an increased susceptibility to HPV. The few who have had this disorder have been distinguished by the abnormal quantity and size of warts that grow on their hands and feet.

Warts will also grow on the rest of their body, including their head, but with less intensity and frequency than those on their limbs.
Currently, the cause for this genetic disorder is unknown, but the specific genes that are mutated have been located. Researchers propose that the genes affected are responsible for proper zinc distribution inside cells. In a normal individual, zinc is properly stored to suppress viral protein formation, since zinc is vital for viruses. In afflicted individuals, virus suppression is limited, resulting in an uncontrolled growth of warts and papules on the skin.

Eventually, Koswara underwent many surgeries to remove the warts that had hindered his life. After nine surgeries, over 12 pounds of warts had been removed from his body — a power saw had to be used to remove those on his hands. Still, what used to be a tangled, thick mass of growths was reduced to the shape of a human hand. Fingers were distinguishable; Koswara, previously unable to eat, write, or perform other activities that required fine motor skills, was now able to regain normal function, including the ability to use a cell phone. However, the warts regrew; doctors will have to perform two surgeries every year for the rest of his life. Koswara will never be fully rid of his condition, but his life is no longer threatened.