Genital warts and vulvar intraepithelial neoplasia: Natural history and effects of treatment and human immunodeficiency virus infection

L. Stewart Massad, Xianhong Xie, Teresa Darragh, Howard Minkoff, Alexandra M. Levine, D. Heather Watts, Rodney L. Wright, Gypsyamber D'Souza, Christine Colie, Howard Strickler

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)831-839
Number of pages9
JournalObstetrics and Gynecology
Volume118
Issue number4
DOIs
StatePublished - Oct 2011

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Condylomata Acuminata
Virus Diseases
Natural History
HIV
Neoplasms
Warts
Therapeutics
CD4 Lymphocyte Count
Confidence Intervals
Vulvar Neoplasms
Squamous Cell Neoplasms
HIV-2

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Genital warts and vulvar intraepithelial neoplasia : Natural history and effects of treatment and human immunodeficiency virus infection. / Massad, L. Stewart; Xie, Xianhong; Darragh, Teresa; Minkoff, Howard; Levine, Alexandra M.; Watts, D. Heather; Wright, Rodney L.; D'Souza, Gypsyamber; Colie, Christine; Strickler, Howard.

In: Obstetrics and Gynecology, Vol. 118, No. 4, 10.2011, p. 831-839.

Research output: Contribution to journalArticle

Massad, L. Stewart ; Xie, Xianhong ; Darragh, Teresa ; Minkoff, Howard ; Levine, Alexandra M. ; Watts, D. Heather ; Wright, Rodney L. ; D'Souza, Gypsyamber ; Colie, Christine ; Strickler, Howard. / Genital warts and vulvar intraepithelial neoplasia : Natural history and effects of treatment and human immunodeficiency virus infection. In: Obstetrics and Gynecology. 2011 ; Vol. 118, No. 4. pp. 831-839.
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abstract = "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.",
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T1 - Genital warts and vulvar intraepithelial neoplasia

T2 - Natural history and effects of treatment and human immunodeficiency virus infection

AU - Massad, L. Stewart

AU - Xie, Xianhong

AU - Darragh, Teresa

AU - Minkoff, Howard

AU - Levine, Alexandra M.

AU - Watts, D. Heather

AU - Wright, Rodney L.

AU - D'Souza, Gypsyamber

AU - Colie, Christine

AU - Strickler, Howard

PY - 2011/10

Y1 - 2011/10

N2 - 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.

AB - 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.

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