Risk factors, management, and HPV genotyping of vulvar intraepithelial neoplasia ( VIN ) in women living with HIV : A comparison with women without HIV and a case control study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Literature on vulvar cancer (VC) and vulvar intraepithelial neoplasia (VIN) in women living with HIV (WLWH) is scarce with no data on human papillomavirus (HPV) genotyping. METHODS: We compared disease characteristics and HPV genotyping on biopsies from WLWH and HIV-negative women (HNW) followed for VIN2+ (VIN2/3 and VC) at Saint-Pierre Hospital between 2000 and 2022. Then, a case control study identified VIN2+ risk factors among WLWH with VIN2+ (cases) and WLWH without VIN followed at the same period (controls), matched for age, ethnicity, and HIV follow-up duration. RESULTS: Compared to 65 HNW (28 VC/37 VIN), 25 WLWH (4 VC/21 VIN) were younger at time of VIN2+ diagnosis (48 vs. 58.7 years, p < 0.001), had more frequently cervical or anal (multicentric) dysplasia (52% vs. 22%, p = 0.02) and non-excisional treatments, and less often healthy margins in excisions (14% vs. 43%, p = 0.02). In WLWH, high-risk HPV was found in 100% (vs. 85% in HNW) with more multiple genotype infections (40% vs. 13%); HPV16 was found in 80% of VC and 73% of VIN in WLWH versus 91% and 79% in HNW. Compared to 75 controls, 25 cases had significantly more frequently prior cervical high-grade intraepithelial lesion (HSIL) (40%), lower median CD4-lymphocyte count (382/μL), and shorter duration of undetectable HIV viremia (4.8 years) than controls (respectively 0%, p = 0.001; 770 CD4/μL, p = 0.021; 10.6 years, p = 0.04). CONCLUSIONS: WLWH develop VIN2+ younger than HNW, with more multiple HPV infections but less HPV 16, more multicentric lesions, and less excisions with negative margins. Risk factors for developing VIN2+ in WLWH include lack of viremia control and immunosuppression.
Source: HIV Medicine
DOI: 10.1111/hiv.70184
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7117647451