title: Vulvar intraepithelial neoplasia: clinical presentation, management and outcomes in women infected with HIV.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aDepartment of Gynecological Oncology bDepartment of Pathology, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Melissa
authors.initials: M
authors.lastname: Bradbury
authors.forename: Silvia
authors.initials: S
authors.lastname: Cabrera
authors.forename: Angel
authors.initials: A
authors.lastname: García-Jiménez
authors.forename: Silvia
authors.initials: S
authors.lastname: Franco-Camps
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Sánchez-Iglesias
authors.forename: Berta
authors.initials: B
authors.lastname: Díaz-Feijoo
authors.forename: Assumpció
authors.initials: A
authors.lastname: Pérez-Benavente
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil-Moreno
authors.forename: Cristina
authors.initials: C
authors.lastname: Centeno-Mediavilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult