AEGiS-13IAC: Increased risk of high-grade vulvar and perianal intraepithelial neoplasia in women infected with human immuno-deficiency virus.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Increased risk of high-grade vulvar and perianal intraepithelial neoplasia in women infected with human immuno-deficiency virus.

Int Conf AIDS 2000 Jul 9-14; 13:41 (abstract no.. LbPeB7037)

Ellerbrock T, Conley LJ, Bush TJ, Chiasson MA, Sawol D, Wright TC;;; Atlanta, GA 30333. Fax: +1 404 639 6118.

BACKGROUND: Little is known about vulvovaginal lesions associated with human papillomavirus (HPV) infection in women infected with human immunodeficiency virus (HIV). This information is needed to develop guidelines for clinical care of these women.

METHOD: A total of 925 women were evaluated at semiannual gynaecologic examinations that included colposcopy and tests for HPV DNA during a median follow-up of 3.2. years.

RESULTS: At the initial examination, HPV-associated vulvovaginal lesions were found in 6 percent of 481 HIV-infected and 1 percent of 437 HIVL, nonfected women (P<0.01), Thirty-three (9 percent) of 385 HIV-infected and 2 (1 percent) of 341 uninfected women, who had no lesions at enrollment, developed vulvovaginal lesions for an incidence of 2.6 and 0.16 cases/100 person-years, respectively (relative risk, 16; P<0.001). Incident lesions in HIV-infected women included 18 vulvar, 2 vaginal, 4 perianal, and 4 multicentric condylomata acuminata and 5 high-grade vulvar and/or perianal intraepithelial neoplasia, while lesions in uninfected women included 1 vulvar and 1 perianal condylomata. Risk factors for incident lesions included HIV infection, HPV infection, lower CD4 +Tlymphocyte level, and history of frequently injecting drugs (all, P<0.05). During follow-up of 28 HIV-infected women with incident condylomata and 25 HIV-infected women with condylomata at enrolment, 4 developed high-grade vulvar intraepithelial neoplasia, one of whom subsequently developed invasive perianal cancer, despite appropriate follow-up and treatment.

CONCLUSIONS: This study demonstrates that HIV-infected women are at increased risk of developing high-grade vulvar and perianal intraepithelial neoplasis. Consequently, we recommend that during each gynaecologic examination HIV-infected women have a thorough inspection of the vulva and perianal region, and women with any abnormality, except for typical, exophytic condylomata acuminata, be referred for colposcopy and biopsy.

Keywords: AEGIS, Papillomavirus, Human, Condylomata Acuminata, Cervical Intraepithelial Neoplasia, Colposcopy, Cervix Neoplasms, HIV, Tumor Virus Infections, HIV Seropositivity, Risk Factors, Incidence, HIV Infections, Vulvar Neoplasms, HIV Seronegativity, Neoplasms, Human, Female, immunology, AIDS
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