More Human Papilloma Virus Shedding With HIV : Vulvar condylomas are multifocal in this population and respond poorly to standard treatments.

In a study that followed cervical disease in HIV-positive and HIV-negative women, he and his coinvestigators have found that about 4% of HIV-positive women developed biopsy-confirmed VIN over 60 months vs. less than 1% of HIV-negative women. And, as with cervical disease, the risk was higher with lower CD4 counts, where almost 20% of those with CD4 counts under 200 developed biopsy-confirmed VIN.

In the WIHS study, incident VIN 2,3 was detected in 8% of HIV-positive women during follow-up and 2% of HIV-negative women, “a relatively high attack rate” of 1.52 per 100 person years among HIV-positive women, vs. 0.36 per 100 person years for HIV-negative women. This indicates that about 1% of HIV-positive women will develop biopsy-confirmed VIN every year, Dr. Wright pointed out.

In the WIHS study, the risk of VIN 2,3 was increased in women with cytologic abnormalities and high-risk HPV types. However, HAART use and CD4 counts did not have a significant impact on incidence, so while HAART is effective in reducing condylomas and CIN, “we're not seeing the same dramatic impact of HAART on VIN incidence, in the studies that have been reported.”

Based on these findings, Dr. Wright recommended a high level of awareness of vulvar disease in HIV-infected patients, and when an HIV-positive patient is referred with an ASCUS (atypical squamous cells of undetermined significance) and LSIL (low-grade squamous intraepithelial lesions) Pap, “be absolutely certain that you do a very careful inspection of the vulva, and do liberal biopsies” of anything that looks abnormal.