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June 27, 2013

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Lymphoma involves the uncontrolled growth of lymph cells that may spread to other organs, including bone marrow, the brain or spinal cord (central nervous system, or CNS lymphoma), and the gastrointestinal tract (GI lymphoma). The Epstein-Barr virus (EBV) may play a role in the development of lymphomas.

The two major types are:

  • Non-Hodgkin's lymphoma (NHL)
  • Hodgkin's lymphoma (also called Hodgkin's disease)

Lymphomas can be more advanced and harder to treat in HIV+ people, especially CNS lymphoma.


  • Swollen lymph nodes
  • Fever, chills, sweats
  • Weight loss
  • Belly pain or swelling; nausea; gassy or bloated stomach (GI lymphoma)
  • Headache; changes in vision, alertness, or personality; confusion; problems with balance (CNS lymphoma)


  • Imaging of the affected area (e.g., CT scan, PET scan, or MRI), especially for GI or CNS lymphoma
  • Biopsy of affected part of the body (e.g., lymph node, lung, intestine, etc.)


  • NHL: Chemotherapy
  • CNS lymphoma: Combination of radiation and chemotherapy
  • GI lymphoma: Combination of surgery to remove tumor and chemotherapy

Cervical Cancer

Cervical cancer is strongly linked to the human papilloma virus (HPV). HPV is the most common sexually transmitted infection in the US. Different strains of HPV cause warts or abnormal cell growth (dysplasia) near the anus or cervix (entrance to the womb).

Dysplasia is more common in women with advanced HIV disease and low CD4 cell counts. It is often more severe and difficult to treat than in HIV-negative women. Untreated dysplasia can lead to cervical cancer, which can be life threatening. HPV may also cause cancer in the vagina, vulva, and anus.

The good news is, when dysplasia is found and treated early, cervical cancer can be prevented. Tests like the Pap smear or VIA (visual inspection with acetic acid) are used to look for changes in the cervix, including dysplasia and cervical cancer. Cervical cancer usually takes years to develop, and it does not usually have symptoms until it is quite advanced. This is why getting screened for cervical cancer on a regular basis is important; screening can catch potential problems before they get worse. For more information on getting a gynecologic exam, see our article on Caring for a Woman's Body.


The other good news is that there are two widely used HPV vaccines: Gardasil (made by Merck; also known as Silgard) and Cervarix (made by GlaxoSmithKline). Both vaccines protect against the types of HPV that cause the most cervical cancers and genital warts. Pregnant women should not receive the vaccine, although it is safe to get the vaccine while breastfeeding.

Both vaccines have been approved by the US Food and Drug Administration (FDA) and are also licensed in many other regions, including Canada, the United Kingdom (UK), and Europe. In the US, Gardasil is approved for females and males ages 9 to 26, while Cervarix is approved for females ages 10 to 25. The same is true in Canada.

The US Centers for Disease Control and Prevention (CDC) recommends HPV vaccines for all girls and young women ages 11 through 26 and all boys and young men ages 11 through 21 (even if they have already become sexually active).

In Canada, the National Advisory Committee on Immunization (NACI) recommends Gardasil vaccination for females and males ages nine through 26, or vaccination with Cervarix for girls and young women ages nine through 26. In the UK, vaccination with Gardasil is offered to girls ages 12 and 13 through the National Health Service.


  • Many women do not experience symptoms
  • Bleeding between periods and bleeding after sexual intercourse are two signs of advanced cervical dysplasia


  • Pap smears

    • A Pap smear is a screening test your health care provider does to check for changes in the cervix
    • It is very important for HIV+ women to have regular gynecologic exams and Pap smears. The CDC recommends that:

      • HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed and when they first seek prenatal care
      • HIV+ women have another Pap smear six months after diagnosis
      • If both tests are normal, a repeat Pap smear should be done every year
    • An abnormal Pap smear can indicate inflammation, infection, dysplasia, or cancer
    • HPV testing can be done in combination with Pap smears to detect the presence of the types of HPV that are higher risk for the development of cancer
  • VIA tests or tests for HPV DNA: Because Pap tests require laboratories and people skilled in reading them, resource-limited countries offer different tests to screen for dysplasia and cervical cancer. One method is called visual inspection with acetic acid, or VIA. When using VIA, health care providers swab acetic acid (also known as vinegar) on the cervix and look directly at it to see if any areas need treatment. Other countries use HPV tests, which test samples taken from your cervix for the presence of HPV's DNA (its genetic material).
  • Colposcopy

    • If you have an abnormal test, you may need a colposcopy (an exam of your cervix using a microscope to look at the tissue more closely)
    • During the colposcopy, your health care provider may remove a tissue sample (biopsy) for laboratory examination to determine if the abnormal cells are cancerous

Treatment for Dysplasia or Cancer That Is Very Localized

  • LEEP (loop electrosurgical excision procedure): Using a thin wire loop with an electrical current to cut away abnormal tissue
  • Cryotherapy: Freezing the cells with liquid nitrogen
  • Laser therapy: Using an intense light to destroy the cells
  • Cold-knife cone biopsy (conization): Cutting the cells out
  • In cases of mild dysplasia, your health care provider may just monitor the cervix by repeat Pap or HPV test

Treatment for Cervical Cancer

Treatment depends on the type of cervical cancer and how far it has spread. Often, more than one kind of treatment is used.

  • Surgery: Hysterectomy (removal of the uterus, including the cervix)
  • Chemotherapy: Drugs (pills and/or intravenous medications) are used to shrink or kill the cancer
  • Radiation: High-energy rays (similar to X-rays) are used to kill the cancer cells
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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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