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      Carcinome épidermoïde de la vulve chez une patiente infectée par le VIH-1 en échec de traitement antirétroviral de première ligne Translated title: Vulvar squamous cell carcinoma in a HIV-1 infected patient with first-line antiretroviral therapy failure

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          Abstract

          Le cancer de la vulve est une affection rarement rapportée dans la littérature. Chez la femme jeune, il est le plus souvent lié à l´infection par le papillomavirus humain (HPV) alors que chez les femmes ménopausées, chez qui ce cancer est plus fréquent, il serait lié à la carence œstrogénique. En outre, l´infection à VIH augmente le risque de survenue chez les femmes séropositives de néoplasies vulvaires du fait de la prévalence élevée de l´infection à HPV chez elles. Ainsi devant toute lésion suspecte de la vulve, une biopsie suivie d´un examen anatomo-pathologique devra être réalisée afin de poser le diagnostic. Nous rapportons le cas d´un carcinome épidermoïde de la vulve chez une patiente séropositive au VIH-1 en échec de traitement antirétroviral (ARV) de première ligne.

          Translated abstract

          Vulvar cancer has been rarely reported in the literature. In young women, it is most often caused by human papillomavirus (HPV), whereas in postmenopausal women, in whom this cancer is more common, it would be caused by estrogen deficiency. Moreover, HIV infection increases the risk of developing vulvar cancer in HIV-positive women as a consequence of the high prevalence of HPV infection in these subjects. Thus, in patients with suspected vulva lesion, biopsy followed by anatomo-pathological examination should be performed in order to establish the diagnosis. We here report a case of vulvar squamous cell carcinoma in a HIV-1-positive patient with first-line antiretroviral therapy (ARV) failure.

          Most cited references16

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          Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium.

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            Vulvar cancer: epidemiology, clinical presentation, and management options

            Epidemiology Vulvar cancer can be classified into two groups according to predisposing factors: the first type correlates with a HPV infection and occurs mostly in younger patients. The second group is not HPV associated and occurs often in elderly women without neoplastic epithelial disorders. Histology Squamous cell carcinoma (SCC) is the most common malignant tumor of the vulva (95%). Clinical features Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain. Therapy The gold standard for even a small invasive carcinoma of the vulva was historically radical vulvectomy with removal of the tumor with a wide margin followed by an en bloc resection of the inguinal and often the pelvic lymph nodes. Currently, a more individualized and less radical treatment is suggested: a radical wide local excision is possible in the case of localized lesions (T1). A sentinel lymph node (SLN) biopsy may be performed to reduce wound complications and lymphedema. Prognosis The survival of patients with vulvar cancer is good when convenient therapy is arranged quickly after initial diagnosis. Inguinal and/or femoral node involvement is the most significant prognostic factor for survival.
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              Incident high-grade squamous intraepithelial lesions in Senegalese women with and without human immunodeficiency virus type 1 (HIV-1) and HIV-2.

              Women infected with human immunodeficiency virus type 1 (HIV-1) and -2 may be at higher risk of developing cervical cancer than uninfected women. We assessed the relationships among human papillomavirus (HPV) types and persistence, HIV-1 and/or HIV-2 infection, and the development of high-grade cervical squamous intraepithelial lesions (HSILs) in a prospective study. We studied 627 women with and without HIV-1 and/or HIV-2 infection and high-risk HPV infection in Senegal, West Africa, who were assessed every 4 months for HSIL and HPV DNA over a mean follow-up of 2.2 years. Cox regression modeling was used to assess risks associated with development of HSIL. During follow-up, 71 (11%) of 627 women developed HSIL as detected by cytology. HIV-infected women with high-risk HPV types were at greatest risk for development of HSIL. In multivariable modeling, infection with oncogenic HPV types--both persistent (hazard ratio [HR] = 47.1, 95% confidence interval [CI] = 16.3 to 136) and transient (HR = 14.0, 95% CI = 3.7 to 54)--was strongly associated with HSIL risk. In univariate analyses, HIV-positive women infected with HIV-2 were less likely to develop HSIL (HR = 0.3, 95% CI = 0.1 to 0.9) than HIV-positive women infected with HIV-1. HIV-positive women with CD4+ cell counts between 200 and 500 cells per microliter (HR = 2.2, 95% CI = 0.8 to 6.3) or fewer than 200 cells per milliliter (HR = 5.5, 95% CI = 2.0 to 15.2) were at greater risk of HSIL than HIV-positive women with CD4 counts of more than 500 cells per milliliter. High plasma HIV RNA levels were associated with increased HSIL risk (HR for each order of magnitude increase in the level of plasma HIV RNA = 1.4, 95% CI = 1.1 to 1.7; P = .005). After adjustment for HPV types and persistence, however, HIV type, plasma HIV RNA level, and CD4 count were no longer statistically significantly associated with increased risk of HSIL. HIV-1 and HIV-2 are associated with increased risk for development of HSIL. This risk appears to be associated primarily with increased HPV persistence that may result from immunosuppression related to HIV-1 and/or HIV-2 infection.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                14 July 2020
                2020
                : 36
                : 181
                Affiliations
                [1 ]UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal,
                [2 ]Service des Maladies Infectieuses et Tropicales du CHNU de Fann, Université Cheikh Anta Diop, Dakar, Sénégal,
                [3 ]Service de Chirurgie Générale, Centre Hospitalier Régional de Saint-Louis, Saint-Louis, Sénégal
                Author notes
                &Auteur correspondant: Alassane Dièye, UFR des Sciences de la Santé, Université Gaston Berger de Saint-Louis, Saint-Louis, Sénégal. vieuxdieye87@ 123456yahoo.fr
                Article
                PAMJ-36-181
                10.11604/pamj.2020.36.181.20628
                7467881
                08a93538-f826-44bd-a8e5-d0018575d741
                Copyright: Alassane Dièye et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 October 2019
                : 03 June 2020
                Categories
                Case Report

                Medicine
                carcinome épidermoïde,vulve,vih,squamous cell carcinoma,vulva,hiv
                Medicine
                carcinome épidermoïde, vulve, vih, squamous cell carcinoma, vulva, hiv

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