Keywords: vulvar intraepithelial neoplasia, inosine pranobex (Groprinosin), broadband radiosurgery, cytokines Vulvar intraepithelial neoplasia in women of reproductive age is associated with human papillomavirus of high carcinogenic risk. In this context, it is relevant to study the frequency of viral load reduction and restore local vaginal immunity in VIN patients receiving antiviral therapy. The objective was to assess the alterations in local vaginal immunity and the expression level of human papillomavirus of high carcinogenic risk in patients with VIN II—III receiving a combination of inosine pranobex therapy and minimally invasive broadband radiosurgery. Material and methods. The study group (n=37) consisted of patients with Grade II—III VIN subjected to broadband radiosurgical vulvectomy accompanied by antiviral therapy; the clinical comparison group (n=21) consisted of patients with II—III Grade VIN who received radiosurgical management only. Concentrations of pro- and anti-inflammatory cytokines in the vaginal contents were measured in microplate wells coated with monoclonal antibodies against pro-inflammatory cytokines, which ensure mobilization of inflammatory response to cytokines IL-1β; IL-2 (interleukins-Iβ, -II) and against anti-inflammatory cytokine limiting the spread of inflammation (interleukin-4 (IL-4). Detection and quantification of the virus were carried out using amplification of the marker agent. Results and discussion. VIN patients of reproductive age have a high viral load: Mav=5.1±0.09 (σ=0.6) and Mav=5.2±0.2 (σ=0.6) in groups I and II, respectively; VIN is accompanied by pronounced suppression of Th2 component in vaginal biotope of women (the median IL4 levels in groups I and II being 4.8 (3.8—6) and 4.4 (3.8—6), respectively) and activation of the Th1 component of local immunity (the median IL-β level in groups I and II being 44 (39—54) and 49 (43—54), respectively); — broadband radiosurgical vulvectomy of the affected vulvar regions using a Surgitron apparatus results in favorable outcome (early primary healing of the postoperative wound and absence of cicatrization at the surgical site); — a combination of broadband radiosurgery and antiviral immunomodulatory therapy with Groprinosin (inosine pranobex) reduces the viral load 6.4-fold; significantly shifts the immunological status of the vaginal biotope towards the Th2 environment (p<0.001): the median IL-4 level is 9 (7.5—10.2) and 4 (3.3—5) in groups I and II, respectively; — for positive effect of anti-VIN therapy to be achieved, inosine pranobex should be preferentially used at the pre- and post-operative stages, in combination with broadband radiosurgical vulvectomy of the affected vulvar regions.
