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Vulvar, Vaginal, and Perianal Intraepithelial Neoplasia in Women With or at Risk for Human Immunodeficiency Virus

From the ¹Women’s Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; ²CONRAD Program, Arlington, Virginia; ³Brown University, Providence, Rhode Island; and ⁴Fred Hutchinson Cancer Research Center, Seattle, Washington.

OBJECTIVE: To compare the incidence of vulvar, vaginal, and perianal intraepithelial neoplasia among human immunodeficiency virus (HIV)–infected women with a group of well-matched high-risk HIV-uninfected controls.

METHODS: A total of 192 HIV-infected and 88 uninfected women at high risk for HIV were followed up prospectively in Providence, Rhode Island during a 6-year period. Pap tests and cervicovaginal lavage for human papillomavirus detection and typing were performed at baseline and every 6 months thereafter. All women referred for colposcopy underwent a full colposcopic evaluation, including the vulvar, vaginal, and perianal regions. Unadjusted hazard ratios with 95% confidence intervals were calculated for development of vulvar, vaginal, and perianal intraepithelial neoplasia using univariable Cox proportional hazards models. An incidence analysis was performed by calculating Kaplan-Meier survival curves for development of intraepithelial neoplasia.

RESULTS: At baseline, 3 (1.6%) of the 192 HIV-infected women and none of the 88 HIV-uninfected women had vulvar, vaginal, and perianal intraepithelial neoplasia. During the study, 16 of 189 (8.5%) HIV-infected women and 1 of 88 (1.1%) HIV-uninfected women developed vulvar, vaginal, and perianal intraepithelial neoplasia. The incidence of vulvar, vaginal, or anal intraepithelial neoplasia was 1.96 per 100 person years for the HIV-infected women and 0.26 per 100 person-years for the HIV-uninfected women (P = .03).

CONCLUSION: Human immunodeficiency virus–infected women had more vulvar, vaginal, and perianal intraepithelial lesions compared with HIV-uninfected women. Furthermore, the incidence rates were higher than has been found in HIV-infected women in other similar cohorts.

LEVEL OF EVIDENCE: II-2

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