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Abstract

Background

HPV-related vulvar cancer is increasing in prevalence, especially in women living with HIV. Treatment of vulva cancer is based on evidence from HPV-independent cancers, which affect older women. The impact of HIV on vulvar cancer characteristics and treatment outcomes needs to be elucidated.

Patients and Methods

A retrospective observational study compared the clinical characteristics, treatment, and outcomes of 92 HIV-positive and 131 HIV-negative women with vulvar cancer at our institution. Using descriptive statistics, HIV-positive and negative patients were compared and Cox regression models were tested for differences in mortality and recurrence.

Results

HIV-positive patients were 20 years younger than HIV-negative patients (p < 0.001). More than 50% of patients presented with advanced stage cancer, however this was independent of HIV-status. Although HIV infection was associated with poorer survival (p = 0.022); rates of cure (p = 0.933) and recurrence rates (p = 0.8) were similar in HIV-positive and negative women.

Conclusions

Vulvar cancer occurs at a much younger age in women living with HIV. Awareness among HIV-positive women and health care providers would lead to diagnosis of vulvar cancer at an earlier stage. Treatment protocols for HPV-related vulvar cancer should not be altered due to HIV status and should take into consideration the young age of the patients.

Keywords

Vulvar neoplasms papillomavirus infection human immunodeficiency virus infection treatment outcome epidemiology women

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References

Gargano

Wilkinson

Unger

, et al. Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar vaccine introduction. J Low Genit Tract Dis 2012; 16: 471–479.

Monk

Burger

Lin

, et al. Prognostic significance of human papillomavirus DNA in vulvar carcinoma. Obstet Gynecol 1995; 85: 709–715.

Al-Ghamdi

Freedman

Miller

, et al. Vulvar squamous cell carcinoma in young women: a clinicopathologic study of 21 cases. Gynecol Oncol 2002; 84: 94–101.

Clifford

Gonc

MAG

. Human papillomavirus types among women infected with HIV : a meta-analysis. AIDS 2006; 20: 2337–2344.

Denny

Boa

Williamson

A-L

, et al. Human papillomavirus infection and cervical disease in human immunodeficiency virus-1–infected women. Obstet Gynecol 2008; 111: 1380–1387.

Maluleke

. STATISTICAL RELEASE P0302 Mid year population estimates 2019. 2019.

Lomalisa

Smith

Guidozzi

. Human immunodeficiency virus infection and invasive cervical cancer in South Africa. Gynecol Oncol 2000; 77: 460–463.

Moodley

Kleinschmidt

. Invasive cervical cancer and human immunodeficiency virus (HIV) infection: a South African perspective. Int J Gynecol Cancer 2001; 11: 194–197.

Kortekaas

Bastiaannet

van Doorn

, et al. Vulvar cancer subclassification by HPV and p53 status results in three clinically distinct subtypes. Gynecol Oncol 2020; 159: 649–656.

10.

Elit

Voruganti

Simunovic

. Invasive vulvar cancer in a woman with human immunodeficiency virus: case report and review of the literature. Gynecol Oncol 2005; 98: 151–154.

11.

MacDuffie

Sakamuri

Luckett

, et al. Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes. Int J Gynecol Cancer 2021; 31: 1328–1334.

12.

Frisch

Biggar

Goedert

. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and aquired immunodeficiency syndrome. J Natl Cancer Inst 2000; 92: 1500–1510.

13.

Langenhoven

Barnardt

Neugut

, et al. Phenotype and treatment of breast cancer in HIV-positive and -negative women in Cape Town, South Africa. J Glob Oncol 2016; 2: 284–291.

14.

Liu

Wang

, et al. Prevalence of human papillomavirus DNA and p16INK4a positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol 2023; 24: 403–414.

15.

Loggenberg

Adams

. A review of vulvar carcinoma at Groote Schuur hospital for the period 2002 to 2012 with particular emphasis on HPV-related disease. South African J Gynaecol Oncol 2020; 12: 17–22.

16.

Taku

Businge

Mdaka

, et al. Human papillomavirus prevalence and risk factors among HIV-negative and HIV-positive women residing in rural Eastern Cape, South Africa. Int J Infect Dis 2020; 95: 176–182.

17.

Sun

Kuhn

Ellerbrock

, et al. Human Papillomavirus infection in women infected with the human immunodeficiency virus. N Engl J Med 1997; 337: 1343–1349.

18.

Palefsky

. Human papillomavirus infection and its role in the pathogenesis of anal cancer. Semin Colon Rectal Surg 2017; 28: 57–62.

19.

Faber

Sand

Albieri

, et al. Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva. Int J Cancer 2017; 141: 1161–1169.

20.

Tesfalul

Simbiri

Wheat

, et al. Oncogenic viral prevalence in invasive vulvar cancer specimens from human immunodeficiency virus-positive and -negative women in Botswana. Int J Gynecol Cancer 2014; 24: 758–765.

21.

Liu

Sharma

Tan

, et al. HIV-positive women have higher risk of HPV infection, precancerous lesions, and cervical cancer: a systematic review and meta-analysis HHS Public Access. AIDS 2018; 32: 795–808.

22.

Julia

Hoang

. A review of prognostic factors in squamous cell carcinoma of the vulva: evidence from the last decade. Semin Diagn Pathol 2021; 38: 37–49.

23.

te Grootenhuis

Pouwer

de Bock

, et al. Margin status revisited in vulvar squamous cell carcinoma. Gynecol Oncol 2019; 154: 266–275.

24.

Coghill

Shiels

Suneja

, et al. Elevated cancer-specific mortality among HIV-infected patients in the United States. J Clin Oncol 2015; 33: 2376–2383.

25.

Eva

Sadler

Thompson

JMD

, et al. HPV-independent and HPV-associated vulvar squamous cell carcinoma: two different cancers. Int J Gynecol Cancer 2022; 32: 1108–1114.

The impact of concurrent HIV-infection on women with vulvar cancer: Comparison of clinical characteristics and outcome