Cervical cancer is preventable and if diagnosed early, curable. Abnormalities in cervical cells and cervical cancer affect many women regardless of HIV status. They are more common in women with HIV, and HIV related immune suppression appears to make cancers more invasive and more likely to recur after treatment.
Early detection and treatment is the key.
Not all abnormalities in cervical cells (a condition called cervical dysplasia) mean that you have cancer or are likely to get it. The pre-cancerous cell abnormalities have been broadly categorised into two groups according to severity: LSIL (Low-grade squamous intra-epithelial lesions), and HSIL (High-grade squamous intra-epithelial lesions). LSIL tends to spontaneously resolve on its own without treatment, though can sometimes progress to HSIL.
If you have a Pap smear that shows high-grade lesions (HSIL), your doctor should immediately refer you for further tests. Pap smears showing LSIL in women with HIV would also be a reason for further testing, unlike LSIL in women without HIV, who would usually have the Pap smear repeated in twelve months, instead of the usual 24 months (for women without HIV).
An examination of the cervix called a colposcopy may be recommended.
The cervix is closely examined under a microscope and cells may be taken for testing. Some people argue that this test should be routine in all HIV positive women, but others disagree, saying it is unnecessary unless Pap smear results are abnormal. If you would feel reassured by having regular colposcopies, speak to your doctor.
Some women can find colposcopy invasive and painful.
Some research has suggested that progression to cervical cancer may be faster in HIV positive women. In addition, recent research has showed that you are at higher risk of a recurrence of cervical dysplasia after surgery when you are HIV positive, especially if your immune system is significantly impaired (CD4 cell count below 200).
Other risk factors
- HPV is the main risk factor, and is present in close to 100% of cervical cancers. The vast majority of women who contract HPV, however, do not go on to have HSIL, let alone cervical cancer.
- Smoking appears to be a risk factor for cervical cancer.
- The risk of developing cervical cancer also increases with age; women may be at increasing risk from their mid-30s.
Effectiveness(Of a drug or treatment). The maximum ability of a drug or treatment to produce a result regardless of dosage. A drug passes efficacy trials if it is effective at the dose tested and against the illness for which it is prescribed. In the standard procedure, Phase II clinical trials gauge efficacy, and Phase III trials confirm it. of treatment
The main reason it is important to detect cervical cancer or precancer early is that it appears current treatments may be more likely to fail in HIV positive women, especially women who have a low CD4 count. Abnormal cells that have been treated (e.g. through laser surgery) may also be more likely to recur.
Vaccines are currently being tested for HPV and initial results have been promising. Even if you have been infected with a strain[HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person). of HPV, a vaccine to protect you from another may be helpful, though at this stage there is not much evidence to guide decision making.
Importance of testing
The main message for HIV positive women in terms of cervical cancer is that early detection is critical. This should include:
- Annual Pap smears;
- Further referral if your Pap smear shows abnormal cells;
- Aggressive treatment in the case of severe dysplasia;
- Maintaining your CD4 count above 200 with ARVA medication or other substance which is active against retroviruses such as HIV. to keep your immune system strong.
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