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. 2022 May 12;11(1):1563.
doi: 10.4102/ajlm.v11i1.1563. eCollection 2022.

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

Fred Maate  1   2 , Peter Julius  2 , Stepfanie Siyumbwa  1 , Leeya Pinder  3 , Trevor Kaile  2 , Mulindi Mwanahamuntu  4 , Groesbeck Parham  5
Affiliations

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

Fred Maate et al. Afr J Lab Med. .

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

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Histological diagnosis of vulvar lesions from women attending the University Teaching Hospital’s gynaecologic clinic, Zambia, 2018.
FIGURE 2
FIGURE 2
P53 and Ki-67 immunostaining photomicrographs of warty vulvar squamous cell carcinoma and basaloid vulvar squamous cell carcinoma among women attending the University Teaching Hospital, Zambia, 2018. (a) Warty vulvar squamous cell carcinoma: Nests of malignant squamous cells are noted surrounded by a desmoplastic stroma. (b) Basaloid vulvar squamous cell carcinoma: Sheets of cells with hyperchromatic nuclei and scant to no cytoplasm are seen with overlying atypical surface epithelium. (c) P53 immunostaining in warty vulvar squamous cell carcinoma. Focal staining is noted. (d) Ki-67 stain. A diffuse nuclear staining pattern is noted.
See this image and copyright information in PMC

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