| Genital warts and vulvar intraepithelial neoplasia: natural history and effects of treatment and human immunodeficiency virus infection. | |
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MedLine Citation:
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PMID: 21934446 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Clinical Trial; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Obstetrics and gynecology Volume: 118 ISSN: 1873-233X ISO Abbreviation: Obstet Gynecol Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-09-21 Completed Date: 2011-11-15 Revised Date: 2013-02-08 |
Medline Journal Info:
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Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: United States |
Other Details:
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Languages: eng Pagination: 831-9 Citation Subset: AIM; IM |
Affiliation:
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Washington University School of Medicine, St. Louis, MO, USA.massadl@wudosis.wustl.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00000797 |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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R01-CA-085178/CA/NCI 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 |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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