Usual or undifferentiated type vulval intraepithelial neoplasia is more common in young women and is usually associated with high-risk human papilloma virus infection. It is associated with the development of basaloid or warty squamous cell carcinoma. Studies have shown that HIV-positive women have an increased risk of VIN and invasive vulval carcinoma but there is a paucity of data about this cohort of women.

To describe the clinical features and treatment response of HIV-positive women diagnosed with vulval intraepithelial neoplasia in a specialist vulval dermatology clinic.

HIV-positive women diagnosed with vulval intraepithelial neoplasia from 2007 to 2013 were retrospectively identified. Data were collected on demographics, clinical features, treatments and outcomes.

Seven cases were retrospectively identified. The median CD4 at presentation was 500 cells/mm³ (range 59–761). Five had multifocal vulval intraepithelial neoplasia. Five were treated with Imiquimod alone, one had surgical excision and one patient was treated with Imiquimod and surgery. Five of the seven had complete resolution of disease.

HIV-positive patients with vulval intraepithelial neoplasia had a good response to treatment with Imiquimod. They were likely to be stable on combined antiretroviral therapy at presentation, have multifocal disease and concurrent vaginal, anal or cervical intraepithelial neoplasia.