title: Effect of antiretroviral therapy on the incidence of genital warts and vulvar neoplasia among women with the human immunodeficiency virus.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence and predictors of genital warts and vulvar intraepithelial neoplasia among women with the human immunodeficiency virus.
  
  
  METHODS
  This was a multicenter prospective cohort study comprised of women without warts or vulvar intraepithelial neoplasia at baseline who underwent CD4 count, human immunodeficiency virus RNA measurement, examination, Papanicolaou test, and biopsy, as indicated, every 6 months. Human papillomavirus DNA typing was examined at baseline.
  
  
  RESULTS
  The incidence of warts among women who were human immunodeficiency virus seronegative was 1.31 versus 5.01 per 100 person-years among women who were seropositive (P < .001). Incidence of vulvar intraepithelial neoplasia among women who were seronegative was 1.31 versus 4.67 per 100 person-years among women who were seropositive (P < .001). In multivariable analysis, warts were associated with highly active antiretroviral therapy (relative hazard, 0.76), CD4 count (relative hazard, 0.91/100 cell/cm(2) increase), acquired immunodeficiency syndrome (relative hazard, 1.25), abnormal Papanicolaou test results (relative hazard, 2.18), high- or medium-risk human papillomavirus types (relative hazard, 1.91), low-risk human papillomavirus types (relative hazard, 1.48), smoking (relative hazard, 1.43), having 1 child (relative hazard, 1.54), and age (relative hazard, 0.74/10 years). Vulvar intraepithelial neoplasia was linked to highly active antiretroviral therapy (relative hazard, 0.65), CD4 count (relative hazard, 0.92), abnormal Papanicolaou test results (relative hazard, 16.03), high- or medium-risk human papillomavirus types (relative hazard, 1.37), and age (relative hazard, 0.85/10 years).
  
  
  CONCLUSIONS
  Warts and vulvar intraepithelial neoplasia are common among women with human immunodeficiency virus. Highly active antiretroviral therapy decreases their incidence.
authors.affiliation: Southern Illinois University School of Medicine, Springfield, Illinois 62794-9640, USA. LSMASSAD@ameritech.net
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: Gayle
authors.initials: G
authors.lastname: Springer
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Nancy
authors.initials: N
authors.lastname: Hessol
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Henry S
authors.initials: HS
authors.lastname: Sacks
authors.forename: Michael
authors.initials: M
authors.lastname: Moxley
authors.forename: D
authors.initials: D
authors.lastname: Heather Watts
mesh_terms: D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003218:Condylomata Acuminata / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D014626:Vaginal Smears; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000453:epidemiology*