Preinvasive and invasive cervical neoplasia in HIV-infected women
- William R Robinson, MD
William R Robinson, MD
- Professor of Gynecologic Oncology
- Tulane Medical School
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Bruce J Dezube, MD
Bruce J Dezube, MD
- Section Editor — Neoplasms in AIDS and Post-Transplantation
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
The relationship between human immunodeficiency virus (HIV) infection and cervical neoplasia was first suspected in 1988 when it was noted that the prevalence of HIV infection was fivefold higher among women attending a colposcopy clinic than among those attending an obstetric clinic serving the same general population (10 versus 2 percent). Two years later, the same investigators described a group of HIV-infected women with invasive cervical cancer . The series was remarkable because of the young age of the patients and because of the severity of the disease: the youngest was a 16 year-old girl with stage IIIB disease. Cervical cancer persisted or recurred in all of the HIV-infected patients despite therapy, but in only 37 percent of HIV-negative women. All of the HIV-infected patients died of cervical cancer, with a mean survival of only 10 months.
As a result of these and other observations, in 1993 the Centers for Disease Control and Prevention (CDC) designated moderate and severe cervical intraepithelial neoplasia as conditions defining a stage of early symptomatic HIV infection (category B), and invasive cervical cancer as an acquired immunodeficiency (AIDS)-defining condition (category C) . (See "The natural history and clinical features of HIV infection in adults and adolescents".)
Cervical cancer is now the most common AIDS-related malignancy in women at some centers in the United States . (See "HIV infection and malignancy: Epidemiology and pathogenesis".)
The incidence of cervical intraepithelial neoplasia (CIN) (as confirmed by colposcopy) is four to five times higher among human immunodeficiency virus (HIV)-infected compared to HIV-negative women or adolescents with high-risk sexual behaviors [4-6].
The increased incidence of CIN in this population was illustrated in a prospective cohort study of 328 HIV-infected and 325 HIV-negative women with no evidence of CIN by Pap test or colposcopy at study entry . Over 30 months follow-up, biopsy confirmed CIN was significantly more likely to develop in HIV-infected compared with HIV-negative women (20 versus 5 percent); most lesions were low grade, and no invasive cancers were noted. Of note, only 54 percent of these women took one or more antiretroviral medications, none were on protease inhibitors, and the mean CD4 cell count for the HIV-infected women was 429 X 10(6)/L.
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- EVALUATION OF ABNORMAL CYTOLOGY
- Low-grade lesions
- Excision or ablation
- Medical therapy
- - Topical 5-fluorouracil
- - Antiretroviral therapy
- Future directions
- DIAGNOSIS OF INVASIVE CANCER
- TREATMENT OF INVASIVE CANCER
- Radiation therapy
- SUMMARY AND RECOMMENDATIONS