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Vaginal Intraepithelial Neoplasia

Clinical Presentation, Management, and Outcomes in Relation to HIV Infection Status

Bradbury, Melissa, MD1; Xercavins, Natalia, MD1; García-Jiménez, Ángel, MD, PhD2; Pérez-Benavente, Asunción, MD, PhD1; Franco-Camps, Silvia, MD1; Cabrera, Silvia, MD, PhD1; Sánchez-Iglesias, José Luis, MD, PhD1; De La Torre, Javier, MD, PhD1; Díaz-Feijoo, Berta, MD, PhD1; Gil-Moreno, Antonio, MD, PhD1; Centeno-Mediavilla, Cristina, MD, PhD1

Journal of Lower Genital Tract Disease: January 2019 - Volume 23 - Issue 1 - p 7–12
doi: 10.1097/LGT.0000000000000431
Original Research Articles: Cervix and HPV
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Objectives The data available on vaginal intraepithelial neoplasia (VAIN) and infection by HIV are scarce. We therefore aimed to review the clinical presentation, management, and survival outcomes of VAIN in this group of women.

Materials and Methods This is an observational cohort study of women diagnosed with VAIN for a 23-year period. Clinical characteristics and outcomes were analyzed according to women's HIV infection status. Disease-free and progression-free survival were compared between groups.

Results Twenty-two of 87 women were HIV positive (25.3%) compared with the HIV-negative group, HIV-positive women were younger (median age = 39 vs 57 years, p < .001) and more frequently smokers (p < .001). They also presented with multifocal and multicentric disease more often (p = .004 and p = .033, respectively) in relation to infection by human papillomavirus. All HIV-positive women were receiving antiretroviral treatment. The median time from the diagnosis of HIV to the development of VAIN was 14 years (range = 1–22 years). There were no significant differences in survival outcomes between groups.

Conclusions HIV-positive women are at an increased risk of developing VAIN and frequently present at a younger age with multifocal and multicentric disease. Vaginal intraepithelial neoplasia lesions can develop many years after the initial diagnosis of HIV infection reason why prolonged surveillance is essential to enable prompt diagnosis and treatment.

1Department of Gynecologic Oncology, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain, and

2Department of Pathology, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain

Correspondence to: Melissa Bradbury, MD, Department of Gynecologic Oncology, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain. E-mail: mbradburylobato@gmail.com

The authors have declared they have no conflicts of interest.

A.G.M. and C.C.M. contributed equally to the work.

The local research and ethics committee approved the study and deemed it part of clinical service provision using the secondary use of fully anonymized data previously collected during normal clinical care.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology