ArticlesHIV-1 infection and risk of vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia: a prospective cohort study
Introduction
In the USA, about 110000–155000 women are infected with HIV-1.1, 2 Women infected with HIV-1 are at increased risk of developing pre-invasive cervical lesions and invasive cervical cancer.3, 4, 5, 6, 7, 8, 9 As a result, in 1993, invasive cervical cancer was designated an AIDS-defining disorder by the US Centers for Disease Control and Prevention.10 Results of several reports suggest that women with HIV-1 infection are at increased risk of developing vulvar, vaginal, and perianal lesions associated with human papillomavirus;11, 12, 13, 14, 15, 16, 17 these lesions include condylomata acuminata, intraepithelial neoplasia (which are pre-invasive lesions), and invasive cancers. Findings of an AIDS-cancer match registry study showed increased rates of in-situ and invasive vulvovaginal lesions associated with human papillomavirus in HIV-1-positive women in the USA.17 However, little is known about the natural history of these lesions in women infected with HIV-1. This information is needed to develop guidelines for clinical care. We did a prospective cohort study to investigate gynaecological disorders associated with HIV-1 infection.
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Study population
From October, 1991, to September, 1998, we enrolled 925 women from the New York City area. Participants included 481 HIV-1-positive women, 437 HIV-1-negative women, and seven women with unknown HIV serostatus. Women infected with HIV-1 were followed up and treated for the disease at local HIV and infectious disease clinics. The cohort and the recruitment protocol are described elsewhere.5, 6
Study participants included 319 women from HIV-AIDS clinics, 142 from methadone maintenance clinics, 282
Results
Age, race and ethnic origin, income, age at first sexual intercourse, and history of cigarette smoking did not differ by much between women infected and not infected with HIV-1 (table 1). However, HIV-1-positive women were significantly more likely to have had human papillomavirus DNA detected in a cervicovaginal lavage sample at enrolment and to have had a history of prostitution, intravenous drug use, and a sexually transmitted disease. At enrolment, CD4 T lymphocyte counts were <200 cells/μL
Discussion
Our study is a comprehensive analysis of the incidence of vulvovaginal and perianal lesions, including intraepithelial neoplasia, in HIV-1-positive women. The incidence of vulvovaginal or perianal lesions was 16 times higher in HIV-1-positive than in HIV-1-negative women, at 2·6 and 0·16 cases per 100 person-years, respectively. Of 33 incident lesions identified in 385 HIV-1-positive women in the incidence analysis, five were high-grade vulvar intraepithelial neoplasia. Additionally, two
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