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Assess HIV-positive women for vulvar, vaginal intraepithelial neoplasia: colposcopy, vulvoscopy key.

BETHESDA, MD. -- HIV-positive women should be assessed for vulvar and vaginal intraepithelial neoplasia, not just cervical intraepithelial neoplasia, according to Dr. Berthe Hollwitz.

Vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN) are not uncommon in women with HIV infection, and they often develop concurrently with high-grade cervical lesions. For this reason, "colposcopy and vulvoscopy are essential diagnostic tools in HIV-infected women," Dr. Hollwitz said at an international conference on malignancies in AIDS and other immunodeficiencies.

She and her associates studied 194 HIV-positive women aged 19-69 years for a median of 27 months to track the development of high-grade vulvar or vaginal lesions. Sixteen subjects (8%) were found to have high-grade VIN or VAIN; 12 of these women had VIN, 3 had VAIN, and 1 had both types.

Fifteen of these 16 women also had cervical intraepithelial neoplasia, said Dr. Hollwitz of the department of gynecologic oncology at the University of Hannover (Germany).

CD4 counts in these subjects were compared with those in an age-matched group of HIV-positive women who either had cervical intraepithelial neoplasia without vaginal or vulvar involvement or who had no human papillomavirus infection, said Dr. Hollwitz at the meeting, which was sponsored by the National Cancer Institute.

Multifocal neoplasia was more likely to occur in women who had the poorest immune status. The average CD4 count was 233 cells/[micro]L in women with multifocal lesions, compared with 386 cells/[micro]L in women who had only cervical lesions and 452 cells/[micro]L in those who were negative for any human papillomavirus.
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Title Annotation:Gynecology
Author:Moon, Mary Ann
Publication:OB GYN News
Date:Sep 1, 2003
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