Agarossi Alberto, Savasi Valeria, Frangipane Chiara, Parisi Francesca, Agarossi Andrea, Dominoni Mattia, Gardella Barbara
Department of Obstetrics and Gynecology, L. Sacco Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.
Department of Biomedical and Clinical Sciences, V. Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.
J Low Genit Tract Dis. 2025 Apr 1;29(2):118-122. doi: 10.1097/LGT.0000000000000864. Epub 2024 Dec 9.
The authors aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH).
The authors retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions.
At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, the authors found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use ( p < .01), genital warts at baseline ( p < .001), HR-HPV test positivity at diagnosis ( p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis ( p < .01).
WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.
作者旨在调查一大群感染艾滋病毒的女性（WLWH）中与人类乳头瘤病毒（HPV）相关的癌前和肿瘤性外阴病变的流行病学情况。
作者回顾性选取了1987年至2020年期间在意大利两家机构接受妇科检查、宫颈细胞学检查、高危（HR-）HPV检测、外阴镜检查以及必要时进行阴道镜检查和靶向活检的1796名WLWH。进行单变量和多变量回归分析，以检验既往史和临床数据与癌前和癌性病变发生之间的关联。
基线时，1796名WLWH中有348名（19.4%）患有尖锐湿疣，30名（1.7%）患有外阴高级别上皮内瘤变（VHSIL），2名（0.1%）患有外阴鳞状细胞癌。在895名随访时间超过1年的WLWH中，作者发现40例（4.5%）新的VHSIL病例和7例（0.8%）外阴癌病例。VHSIL和外阴癌的累积发病率分别为每100人年0.56和0.10。与外阴HSIL和癌症发生独立相关的危险因素包括注射吸毒史（p <.01）、基线时尖锐湿疣（p <.001）、诊断时HR-HPV检测阳性（p <.001）以及诊断时严重免疫抑制（CD4细胞计数<200个/毫升）（p <.01）。
WLWH患外阴高级别上皮内瘤变和癌症的风险很高，尤其是那些有严重免疫抑制的患者。对外阴、会阴和肛门进行仔细检查，可能借助阴道镜检查，应成为艾滋病毒感染女性监测方案的一部分。
