Document Detail


Genital warts and vulvar intraepithelial neoplasia: natural history and effects of treatment and human immunodeficiency virus infection.
MedLine Citation:
PMID:  21934446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV).
METHODS: A cohort of 2,791 HIV-infected and 953 uninfected women followed for up to 13 years had genital examinations at 6-month intervals with biopsy for lesions suspicious for VIN.
RESULTS: The prevalence of warts was 4.4% (5.3% for HIV-seropositive women and 1.9% for HIV-seronegative women, P<.001). The cumulative incidence of warts was 33% (95% confidence interval [CI] 30-36%) in HIV-seropositive and 9% (95% CI 6-12%) in HIV-seronegative women (P<.001). In multivariable analysis, lower CD4 lymphocyte count, younger age, and current smoking were strongly associated with risk for incident warts. Among 501 HIV-seropositive and 43 HIV-seronegative women, warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P=.02), most in the first year after diagnosis. In multivariable analysis, regression was negatively associated with HIV status and lower CD4 count as well as older age. Incident VIN of any grade occurred more frequently among HIV-seropositive than HIV-seronegative women: 0.42 (0.33-0.53) compared with 0.07 (0.02-0.18) per 100 person-years (P<.001). Positivity for VIN 2 was found in 58 women (55 with and three without HIV, P<.001). Two women with HIV developed stage IB squamous cell vulvar cancers.
CONCLUSION: Although genital warts and VIN are more common among HIV-seropositive than HIV-seronegative women, wart regression is common even in women with HIV, and cancers are infrequent.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00000797.
LEVEL OF EVIDENCE: II.
Authors:
L Stewart Massad; Xianhong Xie; Teresa Darragh; Howard Minkoff; Alexandra M Levine; D Heather Watts; Rodney L Wright; Gypsyamber D'Souza; Christine Colie; Howard D Strickler;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  118     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-21     Completed Date:  2011-11-15     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  831-9     Citation Subset:  AIM; IM    
Affiliation:
Washington University School of Medicine, St. Louis, MO, USA.massadl@wudosis.wustl.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00000797
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MeSH Terms
Descriptor/Qualifier:
Adult
CD4 Lymphocyte Count / statistics & numerical data
Cohort Studies
Condylomata Acuminata / epidemiology*,  therapy*
Female
HIV Infections / epidemiology*
Humans
Incidence
Middle Aged
Prevalence
Risk
Smoking / epidemiology
Vulvar Neoplasms / epidemiology*,  therapy*
Grant Support
ID/Acronym/Agency:
R01-CA-085178/CA/NCI NIH HHS; U01 AI035004/AI/NIAID NIH HHS; U01 AI035004-06/AI/NIAID NIH HHS; UL1 RR024131/RR/NCRR NIH HHS; UO1-AI-31834/AI/NIAID NIH HHS; UO1-AI-34989/AI/NIAID NIH HHS; UO1-AI-34993/AI/NIAID NIH HHS; UO1-AI-34994/AI/NIAID NIH HHS; UO1-AI-35004/AI/NIAID NIH HHS; UO1-AI-42590/AI/NIAID NIH HHS; UO1-HD-32632/HD/NICHD NIH HHS
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