Use of ACU-D1 in HPV Associated Vulvar and Perianal Lesions in People With HIV

Inclusion Criteria: * Age 21 years and older * HIV-infected * Able to provide informed consent * Biopsy-proven HSIL disease of the vulvar and perianal region with a total disease volume of 3 cm or greater * Combined antiretrovirals (cART) adherence * CD4 count \> 200 cells/ml * Sustained undetectable viral load for ≥ 3 months * If applicable, on reliable birth control such as combined oral contraceptive pills (OCP), bilateral tubal ligation (BTL), a long-acting reversible contraceptive, or Depo-Provera (birth control shot) * Willingness to conform to study requirements * Reliable follow-up and contact information * No risk factors or clinical suspicion for micro-invasive disease and absence of medical condition that interferes with the conduct of the study in the investigator's opinion Exclusion Criteria: * Currently pregnant (confirmed by collecting urine for HCG pregnancy test) or lactating