INCREASED PREVALENCE OF VULVO-VAGINAL CONDYLOMA AND VULVAR INTRAEPITHELIAL NEOPLASIA IN WOMEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: To compare the prevalence of human papillomavirus (HPV)-ass ociated vulvovaginal lesions in human immunodeficiency virus (HIV)-pos itive and HIV-negative women. Methods: For this cross-sectional study, all participants received a complete gynecologic examination includin g colposcopic evaluation and a structured interview about sociodemogra phic characteristics and risk factors for vulvovaginal disease. In add ition, HPV DNA was assayed for in cervicovaginal lavages using polymer ase chain reaction. Results: Vulvar and/or vaginal condyloma acuminata were detected in 22 of 396 (5.6%) HIV-positive and in 3 of 375 (0.8%) HIV-negative women (odds ratio [OR] 7.3, P < .001). High-grade vulvar intraepithelial neoplasia (VIN) was present in two of the HIV-positiv e and none of the HIV-negative women. Human immunodeficiency virus-pos itive women with condyloma or VIN were significantly more likely to ha ve cervical intraepithelial neoplasia (33%) than those without vulvova ginal lesions (17%) (OR 2.9, 95% confidence interval [CI] 1.1, 74). In multivariate logistic regression analysis, both HIV seropositivity (a djusted OR 5.3, 95% CI 1.3, 35.3) and HPV infection (adjusted OR 6.1, 95% CI 1.7, 39.4) were associated with vulvovaginal condyloma. Conclus ion: The prevalence of vulvovaginal condyloma was increased in HIV-pos itive women even when controlling for HPV infection. Human papillomavi rus-associated disease was more likely to be multicentric and involve the vulva, vagina, and cervix in HIV-positive than HIV-negative women. Detection of high-grade VIN in two of the HIV-positive women suggests that they may also be at risk for developing invasive vulvar carcinom a. (C) 1997 by The American College of Obstetricians and Gynecologists .