title: Vulvar, vaginal, and perianal intraepithelial neoplasia in women with or at risk for human immunodeficiency virus.
abstract: OBJECTIVE
  To compare the incidence of vulvar, vaginal, and perianal intraepithelial neoplasia among human immunodeficiency virus (HIV)-infected women with a group of well-matched high-risk HIV-uninfected controls.
  
  
  METHODS
  A total of 192 HIV-infected and 88 uninfected women at high risk for HIV were followed up prospectively in Providence, Rhode Island during a 6-year period. Pap tests and cervicovaginal lavage for human papillomavirus detection and typing were performed at baseline and every 6 months thereafter. All women referred for colposcopy underwent a full colposcopic evaluation, including the vulvar, vaginal, and perianal regions. Unadjusted hazard ratios with 95% confidence intervals were calculated for development of vulvar, vaginal, and perianal intraepithelial neoplasia using univariable Cox proportional hazards models. An incidence analysis was performed by calculating Kaplan-Meier survival curves for development of intraepithelial neoplasia.
  
  
  RESULTS
  At baseline, 3 (1.6%) of the 192 HIV-infected women and none of the 88 HIV-uninfected women had vulvar, vaginal, and perianal intraepithelial neoplasia. During the study, 16 of 189 (8.5%) HIV-infected women and 1 of 88 (1.1%) HIV-uninfected women developed vulvar, vaginal, and perianal intraepithelial neoplasia. The incidence of vulvar, vaginal, or anal intraepithelial neoplasia was 1.96 per 100 person years for the HIV-infected women and 0.26 per 100 person-years for the HIV-uninfected women (P = .03).
  
  
  CONCLUSIONS
  Human immunodeficiency virus-infected women had more vulvar, vaginal, and perianal intraepithelial lesions compared with HIV-uninfected women. Furthermore, the incidence rates were higher than has been found in HIV-infected women in other similar cohorts.
authors.affiliation: Womens Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. djj0@cdc.gov
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Pangaja
authors.initials: P
authors.lastname: Paramsothy
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.forename: Ann
authors.initials: A
authors.lastname: Duerr
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D014625:Vaginal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D014846:Vulvar Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000821:virology