Project Inform - September, 1998

HIV, HPV and Cervical Cancer

A number of studies have confirmed that a higher percentage of women with HIV are co-infected with human papillomavirus (HPV) than HIV-negative women of the same age, level of drug use and the same number of sexual partners. HPV is the virus that causes genital warts and certain types of cancers (cervical and anal cancers). Risk factors associated with HPV infection include young age at first intercourse, high numbers of sexual partners, sex with men with higher numbers of partners, young age (<30 or 40 years) and smoking. Women with HIV are more likely to have infection with multiple HPV types, often including the "high-risk" HPV types (types 16 and 18), more commonly associated with the development of cervical cancer (42% of infected women vs. 16% of HIV-negative women). In addition, studies have found that 70% of HIV-positive women with low CD4+ counts (<200 cells) had HPV infection. This suggests that as CD4+ counts decline, women are more likely to acquire HPV infection if exposed or that existing virus is reactivated at a stage when the immune system is no longer able to control it.

Not surprisingly, HIV-positive women have higher rates of complications due to HPV infection, such as SIL (squamous intraepithelial lesions) and CIN (cervical intraepithelial neoplasia), types of pre-cancerous abnormalities usually found by pap smear or colposcopy (a small section of cervical tissue). Women co-infected with HIV and HPV who have CD4+ cell counts <200, who are infected by multiple HPV types or by high-risk HPV types, are at the greatest risk of developing these pre-cancerous abnormalities.

Researchers and people with HPV are wondering if highly active antiretroviral therapy (HAART) might help prevent the development of these HPV-related conditions in the first place, especially cancers. Unfortunately, the role of HAART on HPV infection or its complications remains unclear. While current anti-HIV treatments have been shown to reduce development of Kaposi's Sarcoma, at present anti-HIV therapy seems to have no effect on HPV infection or cervical cancer. In theory, by decreasing HIV levels and thereby reducing immune system damage, one may see an improvement in the body's ability to fight infections and thus delay cancer development.

While it is unclear whether HAART can prevent or delay the development of these conditions, preliminary results from one encouraging study do show that effective anti-HIV therapy appears to prevent relapse of one HPV-related condition—genital warts—after initial treatment (see Effects of HAART on HPV Box). It has been shown time and again that people with HIV and HPV infection have higher relapse rates, meaning that despite what appears to be effective treatment of the HPV-related condition, the HPV infection recurs more frequently in people with HIV. While this has been shown with genital warts, longer follow-up studies are needed to see if, over time, women with HIV tend to have higher relapse rates of cervical cancer af-ter initial treatment than HIV-negative women. It remains to be seen if potent anti-HIV therapy can similarly prevent relapse of cervical cancer, CIN and SIL. What is known at present is that women with HIV are more likely than HIV-negative women to harbor HPV infection and develop complications due to HPV. These conditions tend to be more difficult to treat. Future research needs to find out whether HAART can actually prevent or delay the development of such con-ditions altogether and if HAART can reduce re-currence rates after initial treatment as has been shown with genital warts. Because of the long time required for conditions such as cancer to present themselves, there is increasing concern that as people with HIV live longer, these con-ditions could become a larger problem. Thus, it is important that research efforts into treat-ment and prevention of HIV-related cancers be-come a higher priority. It is equally important that women with HIV continue to monitor for HPV infection and its consequences by having a regular (every 6 months) pap smear and, if necessary, a colposcopy. For more information, call the Project Inform hotline for the Women and HIV Discussion Paper.

980901
PI980911

©1998. This document is copyrighted by Project Inform, 205 13th Street, #2001, San Francisco, CA 94103. Treatment Hotline: 800-822-7422 (toll-free) or 415-558-9051 (in the San Francisco Bay Area and internationally) All Project Inform materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited and must include the following text: "From Project Inform, for more information contact the Project Inform National HIV/AIDS Treatment Hotline, 800-822-7422." For permission to edit any Project Inform material for further publication, contact David Evans at the Project Inform office.

Project Inform, established in 1985 as a national, non profit, community-based HIV/AIDS treatment information and advocacy organization, serves HIV-infected individuals, their care-givers, and their healthcare and service providers through its national, toll-free treatment hotline, the PI Perspective and other information publications, educational Town Meetings, on-line services and research and drug access advocacy programs. All information is available free of charge; donations are strongly encouraged. For more information, contact the Project Inform National HIV/AIDS Treatment Hotline. Email: web@projinf.org; Website: http://www.projinf.org.

The original of this article can be found at http://www.projinf.org/pub/25/gynecol.html