Vulvar intraepithelial neoplasia in women with HIV

The increasing incidence of lower genital tract neoplasia in HIV-infected women and the inherent difficulties in diagnosis and treatment have undermined effective management and contributed significantly to the morbidity of this population. The Centers for Disease Control and Prevention has included high-grade squamous intraepithelial lesions, as well as cervical carcinoma in situ, as part of the classification of HIV, with invasive cervical cancer as an AIDS-defining condition. The incidence of vulvar intraepithelial neoplasia (VIN) nearly doubled between 1973 and 1987. In one study, VIN has been reported to occur 29 times more frequently in HIV-infected women than in a control group of self-identified non-HIV-infected women. Because women with HIV are now living longer, they face an increased possibility of the development of these infections along with the long-term sequelae and the risk of transformation to cancer. Treatment of VIN is guided by the size and location of the lesion, the grade of the dysplasia, and identification of coexisting disease in other sites. The case study presented exemplifies many of the management and education issues encountered following women with HIV disease and lower genital tract neoplasia, one of the most difficult issues being that the best mode of treatment for VIN has yet to be determined. Screening of the entire lower genital tract, including the vulva for dysplasia, is recommended for early detection and timely initiation of management.