HIV positive women are at increased risk for the development of abnormal growths on their cervix. These growths are caused by infection with human papilloma virus (HPV), a sexually transmitted infection. In some cases, the growths regress or shrink without treatment. In other cases, the growth may become cancerous. Regular Pap smears and gynecologic examinations are therefore an important part of health care for HIV positive women.
Abnormal cervical lesions can be dealt with in a number of ways, including the following:
However, abnormal growths on the cervix can recur. To compare the recurrence rates among HIV positive and HIV negative women, researchers in Forth Worth, Texas, conducted a study. They found that recurrence rates were significantly greater in HIV positive women.
Study details
Researchers reviewed medical records of 43 HIV positive and 103 HIV negative women, all of whom had been diagnosed with abnormal growths on their cervix. Subjects who had cancer or who had previously undergone a hysterectomy were not included in this study. All subjects who had abnormal growths detected on their cervix (either by Pap smears or biopsy) were initially treated with laser therapy, liquid nitrogen or surgery. Other measures, such as hysterectomy or "cold knife" surgery, were only used if less-invasive therapy failed.
Forty of the 43 HIV positive women were taking combination anti-HIV therapy. Their average CD4+ count was 340 cells. Viral loads were available from the records of 30 subjects. In 19 subjects, the average viral load was about 19,000 copies, while in the remainder it was below the 500 copy mark. Data was collected between January 1996 and December 2000. All subjects were monitored for at least two years.
Results
In general, regardless of treatment, the recurrence of cervical growths was nearly four times higher in HIV positive women than in HIV negative women. In six HIV positive women, hysterectomy was performed because of recurring cervical growths. In three of the six women, precancerous cells were found to have spread into the vagina. No subject died while in this study.
Researchers found that women who had fewer than 200 CD4+ cells often had a higher rate of recurrence of abnormal growths on their cervix compared to women who had higher CD4+ cell counts.
This study highlights the need for HIV positive women to receive regular gynecologic care. It also reveals the need for therapies that can improve the immune system's ability to control tumours.
REFERENCES
1. Tate DR and Anderson RJ. Recrudescence of cervical dysplasia among women who are infected with the human immunodeficiency virus: a case-control analysis. American Journal of Obstetrics and Gynecology 2002;186:880-882.
2. Baldwin P and Sterling J. HIV-1 infection and intraepithelial neoplasia of lower genital tract. Lancet 2002;359:2040.
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