Original Research

High-risk human papillomavirus-associated vulvar neoplasia among women living with human immunodeficiency virus in Zambia

Fred Maate, Peter Julius, Stepfanie Siyumbwa, Leeya Pinder, Trevor Kaile, Mulindi Mwanahamuntu, Groesbeck Parham
African Journal of Laboratory Medicine | Vol 11, No 1 | a1563 | DOI: https://doi.org/10.4102/ajlm.v11i1.1563 | © 2022 Fred Maate, Peter Julius, Stepfanie Siyumbwa, Leeya Pinder, Trevor Kaile, Mulindi Mwanahamuntu, Groesbeck Parham | This work is licensed under CC Attribution 4.0
Submitted: 21 February 2021 | Published: 12 May 2022

About the author(s)

Fred Maate, Department of Pathology and Microbiology, Adult and Emergency Hospital, University Teaching Hospitals, Lusaka, Zambia; and, Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
Peter Julius, Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
Stepfanie Siyumbwa, Department of Pathology and Microbiology, Adult and Emergency Hospital, University Teaching Hospitals, Lusaka, Zambia
Leeya Pinder, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States
Trevor Kaile, Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
Mulindi Mwanahamuntu, Department of Obstetrics and Gynaecology, Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia
Groesbeck Parham, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States


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Abstract

Background: Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negative women. Vulvar neoplasia among women living with HIV has not previously been characterised in Zambia.

Objective: This study determined the clinical and pathologic features of vulvar neoplasia among women living with HIV at the University Teaching Hospital, Lusaka, Zambia.

Methods: We conducted a cross-sectional study of vulvar lesions among 53 women living with HIV who presented with vulvar lesions between July 2017 and February 2018. The study assessed clinical and histological characteristics and prevalence of high-risk human papillomavirus (HRHPV).

Results: Twenty-one patients were diagnosed with vulvar squamous cell carcinoma (VSCC), 20 with usual vulvar intraepithelial neoplasm (uVIN), and the rest with either benign lesions or non-neoplastic lesions (NNL). Participants’ mean age was 40 years. Patients with VSCC were significantly older than those with NNL (mean (s.d.): 43 (21) vs 33 (10), p = 0.004). The prevalence of HRHPV was 88.9% in VSCC patients and 100.0% in high-grade squamous intraepithelial lesion patients. HPV16 was the most common (52.6%) genotype. The clinical features of neoplasia were similar to those of NNL.

Conclusion: VSCC was significantly more common among women aged ≥ 40 years. HRHPV in VSCC and high-grade squamous intraepithelial lesions was high. Women with vulvar lesions, especially those aged > 40 years, should be evaluated for vulvar cancer. Young girls should be vaccinated to prevent vulvar cancer.


Keywords

vulvar neoplasia; vulvar cancer; human papillomavirus virus; HIV; Zambia

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