Human Papillomavirus-Associated Vulvar Intraepithelial Neoplasia in an Immunocompromised Patient—When Excisional Treatment Is Not Possible

Human papillomavirus-associated vulvar intraepithelial neoplasia (HPVa VIN) is a premalignant condition. Its main risk factors include human papillomavirus (HPV) infection, smoking, and immunodeficiency. Excisional treatment is preferred, but if contraindicated, topical imiquimod may be considered. The prognosis appears to be similar after these two treatments. Still, there are few studies in women living with human immunodeficiency virus (HIV) to draw a conclusion in this group. We present the case of a woman living with HIV and meeting diagnostic criteria for acquired immunodeficiency syndrome (AIDS), with extensive, multifocal, and recurrent HPVa VIN. Due to anesthetic contraindications, we opted for topical imiquimod treatment, with good results, achieving a complete clinical response after 18 weeks of treatment. Two months later, a clinically suspected recurrence was detected, and imiquimod was reinitiated. Complete clinical resolution was again achieved after 20 weeks of treatment, and the patient started clinical surveillance every 3 months.