Vulvar intraepithelial neoplasia: clinical presentation, management and outcomes in women infected with HIV

作者：Bradbury Melissa^*; Cabrera Silvia; Garcia Jimenez Angel; Franco Camps Silvia; Luis Sanchez Iglesias Jose; Diaz Feijoo Berta; Perez Benavente Assumpcio; Gil Moreno Antonio; Centeno Mediavilla Cristina

来源：AIDS, 2016, 30(6): 859-867.

DOI：10.1097/QAD.0000000000000984

• HIV
• human papillomavirus
• multicentric disease
• multifocal disease
• progression
• recurrence
• vulvar intraepithelial neoplasia

Objective:Immunocompromised patients are at increased risk of developing preinvasive lesions of the lower genital tract. There are a limited number of studies on vulvar intraepithelial neoplasia (VIN) in HIV-positive women. We aimed to review the clinical presentation of VIN, management and survival outcomes in this group of patients.Design:Observational cohort study.Methods:Data was collected from women diagnosed with VIN at the Hospital Vall d'Hebron between September 1994 and October 2011. The main outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS). Risk factors for recurrence and progression were assessed using univariate and multivariate analyses.Results:Thirty-seven out of 107 women were HIV positive (34.6%). The median follow-up time was 32 (range 12-179) months. Compared with the HIV-negative group, HIV-positive women were younger (median age 37 vs. 44 years, P=0.003) and presented with multifocal and multicentric disease more frequently (63.6 vs. 22.2% and 84.8 vs. 43.3%, respectively, P<0.0001). RFS and PFS were lower in the HIV-positive group (42.4 vs. 71.4% P=0.043 and 69.7 vs. 95.2% P=0.006, respectively). RFS was significantly associated to multicentric and multifocal disease on multivariate analysis. PFS was associated to HIV infection on univariate analysis.Conclusion:HIV-positive women are at increased risk of developing VIN and frequently present at a younger age with multifocal and multicentric disease. They have shorter RFS and PFS compared with HIV-negative women. Close surveillance of the lower genital tract is mandatory to enable early recognition and treatment of any suspicious lesions. Close follow-up after treatment of VIN is essential to exclude early recurrence or progression.