Bradbury Melissa, Cabrera Silvia, García-Jiménez Angel, Franco-Camps Silvia, Sánchez-Iglesias Jose Luis, Díaz-Feijoo Berta, Pérez-Benavente Assumpció, Gil-Moreno Antonio, Centeno-Mediavilla Cristina
aDepartment of Gynecological Oncology bDepartment of Pathology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
AIDS. 2016 Mar 27;30(6):859-68. doi: 10.1097/QAD.0000000000000984.
Immunocompromised patients are at increased risk of developing preinvasive lesions of the lower genital tract. There are a limited number of studies on vulvar intraepithelial neoplasia (VIN) in HIV-positive women. We aimed to review the clinical presentation of VIN, management and survival outcomes in this group of patients.
Observational cohort study.
Data was collected from women diagnosed with VIN at the Hospital Vall d'Hebron between September 1994 and October 2011. The main outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS). Risk factors for recurrence and progression were assessed using univariate and multivariate analyses.
Thirty-seven out of 107 women were HIV positive (34.6%). The median follow-up time was 32 (range 12-179) months. Compared with the HIV-negative group, HIV-positive women were younger (median age 37 vs. 44 years, P = 0.003) and presented with multifocal and multicentric disease more frequently (63.6 vs. 22.2% and 84.8 vs. 43.3%, respectively, P < 0.0001). RFS and PFS were lower in the HIV-positive group (42.4 vs. 71.4% P = 0.043 and 69.7 vs. 95.2% P = 0.006, respectively). RFS was significantly associated to multicentric and multifocal disease on multivariate analysis. PFS was associated to HIV infection on univariate analysis.
HIV-positive women are at increased risk of developing VIN and frequently present at a younger age with multifocal and multicentric disease. They have shorter RFS and PFS compared with HIV-negative women. Close surveillance of the lower genital tract is mandatory to enable early recognition and treatment of any suspicious lesions. Close follow-up after treatment of VIN is essential to exclude early recurrence or progression.
免疫功能低下的患者发生下生殖道癌前病变的风险增加。关于HIV阳性女性外阴上皮内瘤变（VIN）的研究数量有限。我们旨在回顾该组患者VIN的临床表现、治疗及生存结局。
观察性队列研究。
收集1994年9月至2011年10月在比埃斯堡医院诊断为VIN的女性的数据。主要结局指标为无复发生存期（RFS）和无进展生存期（PFS）。使用单因素和多因素分析评估复发和进展的危险因素。
107名女性中有37名HIV阳性（34.6%）。中位随访时间为32（范围12 - 179）个月。与HIV阴性组相比，HIV阳性女性更年轻（中位年龄37岁对44岁，P = 0.003），且多灶性和多中心性疾病的发生率更高（分别为63.6%对22.2%和84.8%对43.3%，P < 0.0001）。HIV阳性组的RFS和PFS较低（分别为42.4%对71.4%，P = 0.043；69.7%对95.2%，P = 0.006）。多因素分析显示RFS与多中心性和多灶性疾病显著相关。单因素分析显示PFS与HIV感染有关。
HIV阳性女性发生VIN的风险增加，且发病年龄通常较小，多为多灶性和多中心性疾病。与HIV阴性女性相比，她们的RFS和PFS更短。必须密切监测下生殖道，以便早期识别和治疗任何可疑病变。VIN治疗后密切随访对于排除早期复发或进展至关重要。
