Impact of a delayed diagnosis of vulvar cancer and its association with HIV infection: A 4-year review at a tertiary hospital in KwaZulu-Natal, South Africa

BACKGROUND: Vulvar cancer is becoming more common in young women owing to the increased prevalence of co-infection with human papillomavirus and HIV. OBJECTIVES: The aim of this study was to determine the impact of the time interval from the diagnosis of vulvar cancer at the referring institution to the tertiary hospital and to evaluate the impact of HIV infection in the study population. METHOD: This was a retrospective descriptive chart review. RESULTS: A total of 86 cases of vulvar cancer were analysed. The mean age was 48.2 ± 12.5. Sixty (69.8%) patients were under 50 years of age and eight (9.3%) under 30 years. The interval from the onset of symptoms to the diagnosis of cancer was > 12 months in 63 (73.3%) patients. Eighty-one (94.8%) had had symptoms treated multiple times prior to diagnosis. Seventy (81.4%) were referred to the tertiary institution within 3 months of the diagnosis of cancer. Seventy (81.4%) had concomitant HIV infection. Of those with CD4 counts of > 200 cells/mm(3), 61.7% had early-stage vulvar cancer, while 38.3% had late-stage disease (P = 0.048). There was no association between the viral load and the Federation of Gynaecology and Obstetrics stage (P = 0.401). The primary treatment was surgery in 50%. CONCLUSION: Although the study was retrospective, we found that vulvar cancer was prevalent in younger patients with HIV infection. Higher CD4 counts were associated with early-stage disease. Early sampling of suspicious lesions can ensure early diagnosis of vulvar cancer and the initiation of therapeutic interventions, particularly in HIV-infected patients.