Vulvar and vaginal intraepithelial neoplasia in HIV-infected women
- William R Robinson, MD
William R Robinson, MD
- Professor of Gynecologic Oncology
- Tulane Medical School
Women with human immunodeficiency virus (HIV) infection are at an increased risk of vulvar and vaginal neoplasia [1-5]. As with cervical neoplasia, the incidence and severity of vulvar and vaginal premalignant and malignant disease appear to correlate with worsening immunosuppression [6-8]. Furthermore, despite standard therapy, HIV-infected women with vulvar or vaginal neoplasia have higher rates of persistence and recurrence than the general population, again similar to cervical neoplasia [9,10].
Screening, diagnosis, and treatment for vulvar and vaginal intraepithelial neoplasia in HIV-infected women will be reviewed here. Vulvar and vaginal neoplasia in the general population are discussed separately. (See "Vulvar intraepithelial neoplasia" and "Vaginal intraepithelial neoplasia".)
The Vulvar Oncology Subcommittee of the International Society for the Study of Vulvar Diseases (ISSVD) published a classification system for vulvar intraepithelial neoplasia (VIN) in 2004 . The term VIN was limited to histologically high-grade squamous lesions (formerly termed VIN 2 and VIN 3), for which treatment is indicated to prevent progression to cancer . Lesions previously referred to as VIN 1 were no longer classified as VIN. This topic review will adhere to the 2004 ISSVD nomenclature except when data are reported from studies that used the previous classification. (See "Vulvar intraepithelial neoplasia", section on 'Terminology'.)
Vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN) are precursors to vulvar and vaginal cancer and are more common in women infected with human immunodeficiency virus (HIV) [12-14]. In the general United States population, the estimated incidence of VIN and VAIN is 2.9 and 0.2 to 0.3 per 100,000 women, respectively. (See "Vaginal intraepithelial neoplasia", section on 'Epidemiology' and "Vulvar intraepithelial neoplasia", section on 'Epidemiology and risk factors'.)
The incidence of VIN and VAIN in HIV-infected women has not been extensively studied, but the available data are consistent with increased risk:
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- Robinson WR. Long-Term Follow-Up of HIV-Infected Women with Cervical Dysplasia. AIDS Patient Care STDS 2015; 29:517.
- CLINICAL MANIFESTATIONS
- DIAGNOSTIC EVALUATION
- Vulvar neoplasia
- - Vulvar examination
- - Vulvar colposcopy and biopsy
- Vaginal neoplasia
- - Vaginal examination
- - Vaginal cytology, colposcopy, and biopsy
- Vulvar neoplasia
- Vaginal neoplasia
- Highly active antiretroviral therapy
- SUMMARY AND RECOMMENDATIONS