Human papillomavirus is associated with the frequent detection of warty and basaloid high-grade neoplasia of the vulva and cervical neoplasia among immunocompromised women.
A total of 158 women who either HIV-infected or under iatrogenic immunosuppression were examined regularly during a 4-year period to evaluate if certain vulvar neoplasms and cervical neoplasia have similar associated risk factors. Patients with CIN were matched prospectively with immunocompetent controls with CIN. Forty-eight cervical lesions were detected among patients, including 2 invasive carcinoma and 15 CIN-3 lesions, compared to 11 vulvar lesions, including 2 invasive carcinoma and 7 VIN-3 lesions. Women who have more than five life-time partners were more likely to have HPV-DNA positive cervical swabs and vulvar scrapes as well as cervical and/or vulvar neoplasia. Compared to 2.7% of controls 15.2% of patients with CIN had coexisting high-grade lesions of the vulva. With 1 exception all patients with vulvar neoplasia either suffered from symptomatic immunodeficiency or received immunosuppressive drugs for more than 10 years. Except for 1 VIN-3 lesions, all vulvar neoplasms were associated with HPV-DNA types 16, 31, and/or 33. Six of nine patients as well as the 2 controls with coexisting vulvar and cervical neoplasia had the same HPV-type associated with both lesions. All vulvar lesions were classified as either "warty" or "basaloid". In conclusion cervical and bowenoid/basaloid vulvar neoplasia seem to have a similar HPV-related genesis. Malfunction of the cellular immune response appears to be a cofactor in the genesis of HPV-associated neoplasia at both sites.
Petry
K U
KU
Department of Gynecological Oncology, University of Hannover, Germany.
Köchel
H
H
Bode
U
U
Schedel
I
I
Niesert
S
S
Glaubitz
M
M
Maschek
H
H
Kühnle
H
H
D016022:Case-Control Studies; D003218:Condylomata Acuminata / Q000821:virology*; D015344:DNA Probes, HPV; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D018295:Neoplasms, Basal Cell / Q000821:virology*; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D011446:Prospective Studies; D002577:Uterine Cervical Diseases / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000821:virology*; D014845:Vulvar Diseases / Q000821:virology*; D014846:Vulvar Neoplasms / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000821:virology
D015344:DNA Probes, HPV