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HIV-Infected Women May Be at Increased Risk of Vulvar Cancer

NEW YORK (Reuters Health) Jan 10 – Much emphasis has been placed on the link between HIV infection and cervical cancer, but study findings published in the January 12th issue of The Lancet suggest that HIV-infected women are also at increased for vulvar cancer.

Dr. Thomas C. Wright, from Columbia University in New York, and colleagues assessed the incidence of vulvovaginal and perianal disease in 925 women who underwent twice yearly gynecologic examination for close to 3 years. The study group included 481 HIV-1-positive women, 437 HIV-1-negative women, and 7 women of unknown serostatus.

At study entry, 6% of HIV-infected women had vulvovaginal/perianal condylomata acuminata or intraepithelial neoplasia compared with only 1% of HIV-negative women (p < 0.0001).

The women without disease at enrollment were included in an incidence analysis, the authors note. During the study period, HIV-infected women were 16 times more likely to develop vulvovaginal or perianal lesions than were HIV-negative women (p < 0.0001). Further analysis revealed that HIV-1 infection and human papillomavirus infection, decreased CD4+ cell count, and history of frequent injection drug use were risk factors for incident lesions.

"In the early 1990s we started a long-term prospective study looking at the gynecologic manifestations of HIV infection," Dr. Wright told Reuters Health. "Through the study we noticed a lot of cervical disease," he said. "But toward the end we realized that we were beginning to see an increase in vulvar disease," he added.

"I think we all sort of expected that there would be an increase in vulvar disease because we had noticed an increase in other immunosuppressed patients," Dr. Wright noted. "Still, vulvar disease is relatively uncommon compared with cervical disease."

Dr. Wright said that "most internists and gynecologists are really tuned in to looking for cervical disease in HIV-infected women." The current report "is really the first documentation that HIV-infected women are at increased risk for developing vulvar disease," he added. "This means that clinicians need to start paying more attention to the vulva so they can prevent the development of vulvar cancer."

Lancet 2002;359:108-113.

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