Prevalence of and Factors Associated with Vulva Intraepithelial Neoplasia (VIN) among HIV Positive Women at Mbarara Regional Referral Hospital, Uganda

Abstract

Background: Vulva intraepithelial neoplasia (VIN) is a noninvasive potential precursor of squamous cell carcinoma of the vulva. VIN is more prevalent in HIV-positive than HIV-negative women and if not identified and treated early, there is a high risk of progression to invasive cancer. Despite a large number of HIV-positive women getting care from Immunesuppression (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), the local burden of VIN remains unknown in this group. Objective: To determine the prevalence and factors associated with vulva intraepithelial neoplasia (VIN) among HIV-positive women attending HIV care clinic at Mbarara Regional Referral Hospital (MRRH). Methods: This cross sectional study consisted of 225 HIV-positive women who attended the HIV care clinic at MRRH in a period of three months. Simple random sampling was used in the recruitment of study participants until the sample size was achieved. All participants underwent vulvoscopy. Any lesion detected was biopsied. Demographic and medical data were collected. The dependent variable was histologically confirmed VIN. Logistic regression analysis to assess association of factors with VIN was done. Results were presented in charts, graphs and tables.  Results: Two hundred and twenty five HIV-positive women were enrolled. Their median age was 33 years.  14 (6.22%) had VIN; of these, 9 had VIN-1, 4 had VIN-2 and 1 had VIN-3. All the study participants with VIN had Human papilloma virus (HPV) infection and were on antiretroviral therapy (ART). The symptoms of VIN included vulvar itching (43%), vulvar burning sensation (29%), and superficial dyspareunia (14%). Age, multiple sexual partners, age of sexual debut, menarche and genital warts were not significantly associated with VIN Conclusion: The prevalence of VIN among HIV-positive women attending HIV care clinic at MRRH is low. All participants with VIN had the following in common, HPV infection; vulva itching, vulva burning sensation and superficial dyspareunia. Recommendations: Since all cases of VIN had HPV infection we recommend that HPV vaccination should be included in HIV care to prevent VIN and consequently vulva cancer. We also recommend that all women with vulva itching, vulva burning and superficial dyspareunia should be screened for VIN.

Key words: Vulva Intraepithelial Neoplasia (VIN), Human Immunodeficiency Virus (HIV)