Washington University School of Medicine, St. Louis, MO,
Obstet Gynecol. 2011 Oct;118(4):831-9. doi: 10.1097/AOG.0b013e31821a0f4d.
To describe the natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV).
A cohort of 2,791 HIV-infected and 953 uninfected women followed for up to 13 years had genital examinations at 6-month intervals with biopsy for lesions suspicious for VIN.
The prevalence of warts was 4.4% (5.3% for HIV-seropositive women and 1.9% for HIV-seronegative women, P<.001). The cumulative incidence of warts was 33% (95% confidence interval [CI] 30-36%) in HIV-seropositive and 9% (95% CI 6-12%) in HIV-seronegative women (P<.001). In multivariable analysis, lower CD4 lymphocyte count, younger age, and current smoking were strongly associated with risk for incident warts. Among 501 HIV-seropositive and 43 HIV-seronegative women, warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P=.02), most in the first year after diagnosis. In multivariable analysis, regression was negatively associated with HIV status and lower CD4 count as well as older age. Incident VIN of any grade occurred more frequently among HIV-seropositive than HIV-seronegative women: 0.42 (0.33-0.53) compared with 0.07 (0.02-0.18) per 100 person-years (P<.001). Positivity for VIN 2 was found in 58 women (55 with and three without HIV, P<.001). Two women with HIV developed stage IB squamous cell vulvar cancers.
Although genital warts and VIN are more common among HIV-seropositive than HIV-seronegative women, wart regression is common even in women with HIV, and cancers are infrequent.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00000797.
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描述人类免疫缺陷病毒（HIV）感染者女性生殖器疣和外阴上皮内瘤变（VIN）的自然病史。
一项对 2791 名 HIV 感染者和 953 名未感染者进行的队列研究，随访时间长达 13 年，每 6 个月进行一次生殖器检查，并对疑似 VIN 的病变进行活检。
疣的患病率为 4.4%（HIV 血清阳性者为 5.3%，HIV 血清阴性者为 1.9%，P<.001）。HIV 血清阳性者的累积疣发病率为 33%（95%可信区间[CI] 30-36%），HIV 血清阴性者为 9%（95% CI 6-12%）（P<.001）。多变量分析显示，较低的 CD4 淋巴细胞计数、较年轻的年龄和当前吸烟与疣的发病风险呈强相关。在 501 名 HIV 血清阳性和 43 名 HIV 血清阴性的女性中，疣在 410 名（82%）血清阳性和 41 名（95%）血清阴性的女性中消退（P=.02），大部分在诊断后的第一年。多变量分析显示，消退与 HIV 状态、较低的 CD4 计数以及年龄较大呈负相关。与 HIV 血清阴性者相比，HIV 血清阳性者新发任何等级的 VIN 更为常见：每 100 人年 0.42（0.33-0.53）比 0.07（0.02-0.18）（P<.001）。58 名女性中发现 VIN 2 阳性（55 名有 HIV，3 名无 HIV，P<.001）。两名 HIV 阳性妇女发生了 IB 期鳞状细胞外阴癌。
尽管 HIV 血清阳性者中生殖器疣和 VIN 比 HIV 血清阴性者更常见，但即使在 HIV 阳性者中，疣的消退也很常见，癌症也很少见。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00000797。
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