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Human Papilloma Virus (HPV) and HIV/AIDS

June 29, 2015

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Cervical Dysplasia and Cervical Cancer

Certain types of HPV can cause abnormal cells to form. This is called dysplasia. The main place dysplasia occurs is on the cervix (entrance to the womb). Other less common areas are the vagina, vulva, and anus. Dysplasia is not cancer, but if left untreated, it can develop into cancer. For this reason, cells with dysplasia are sometimes referred to as pre-cancerous cells.

Screening for dysplasia and cervical cancer is essential to find and treat early pre-cancerous changes and to prevent cervical cancer. Traditionally, the Papanicolaou test (Pap test or Pap smear) has been done. This test uses a small brush to collect a few cells to check for changes in the cervix. Now, liquid based systems to screen samples of cervical cells are much more common and are effective for finding abnormal cells.

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).

Cervical cancer usually takes years to develop, but it does not have symptoms until it is quite advanced. This is why getting screened on a regular basis is important; screening can catch potential problems before they get worse. It is especially important for women living with HIV to have regular cervical screening tests every year. This is because women living with HIV are more likely to have abnormal cervical screening tests than HIV-negative women.

Cervical cancer can be life threatening. It is one of the few AIDS-defining conditions specific to women. Fortunately, it can be prevented through early diagnosis and treatment.

Symptoms:

  • Many women do not experience symptoms
  • In very advanced stages, a woman may experience abdominal pain, vaginal discharge, bleeding after having vaginal sex, and bleeding between periods

Screening and Diagnosis

In the US:

  • Women living with HIV should have a complete gynecological examination, including a cervical screening test and a pelvic exam, when they are first diagnosed, and then another test six months later
  • If both tests are normal, a repeat cervical screening test should be done every year
  • Women living with HIV who have had dysplasia in the past should receive a cervical screening test every six months
  • Pregnant women living with HIV should have a cervical cancer screening test when they first seek prenatal care
  • Women who were born with HIV (perinatally infected) are more at risk of having high-risk types of HPV; therefore, cervical screening should start prior to age 21 if they are sexually active
  • An abnormal cervical screening test can indicate inflammation, infection, dysplasia, or cancer
  • If you have an abnormal cervical screening test, you will need a colposcopy (an exam of your cervix using a magnifier to look at the tissue more closely) and a biopsy (a small amount of tissue is removed so it can be checked under a microscope for signs of cancer)
  • An HPV test can be used along with the cervical screening test to look for high-risk types that may lead to cancerous and pre-cancerous conditions. Speak with your health care provider to see if your cervical screening test includes an HPV test.

From the World Health Organization (WHO):

  • Women living with HIV should be screened for cervical cancer, regardless of age
  • Women living with HIV should be screened for cervical cancer regularly (e.g., once a year)
  • If you have a VIA or HPV test that shows an abnormality, you may need treatment (see below); which screening tests and treatments are available will depend on where you live

Many countries have screening and diagnosis guidelines that differ from the WHO and US guidelines listed above. Please check with your country or region to see what the standard of care is in your area.

Treatment for Cervical Dysplasia

If you have dysplasia, discuss treatment choices with your health care provider. Most treatments focus on destroying the abnormal cells so that they do not become cancer.

  • Laser therapy: Using an intense light to destroy the cells
  • Cold-knife cone biopsy (conization): Cutting the cells out (an operation)
  • LEEP: Loop electrosurgical excision procedure, which uses a thin electrified wire loop to cut out the cells
  • Cryotherapy: Freezing the cells with liquid nitrogen
  • In cases of mild dysplasia, your health care provider may just monitor the cervix by colposcopy, repeat cervical screening tests, and/or an HPV test

Cervical dysplasia is more common in women living with HIV who have advanced HIV disease and low CD4 cell counts. Cervical dysplasia is often more serious and difficult to treat in women living with HIV than HIV-negative women.

Treatment of Cervical Cancer

Cervical cancer is most treatable when it is diagnosed and treated early, so regular cervical screening tests are extremely important. Treatment depends on the type of cervical cancer and how far it has spread. Often, more than one kind of treatment is used. Treatments include:

  • Surgery: Cancer tissue is cut out in an operation
  • 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

For more information, see our article on Cancers.


Anal Dysplasia and Anal Cancer

Certain types or strains of HPV may cause dysplasia and cancer in the anus. Although the risk of developing dysplasia is higher among men who have sex with men, women are also at risk, especially those living with HIV or who have had receptive anal sex with a man.

Symptoms:

  • Many women do not experience symptoms
  • Anal or rectal bleeding, irritation, itching, or burning
  • In very advanced stages, there may be abscesses, lumps, ulcers, and anal discharge

Screening and Diagnosis

  • Careful physical examination by a health care provider may be the best way to find anal cancers
  • An abnormal anal Pap test may be a sign of dysplasia or cancer
  • Your provider may also perform a digital rectal exam (DRE), in which she/he slides a lubricated, gloved finger through your anus and into your rectum to feel for abnormal masses
  • If you have symptoms, you may need an anoscopy (an exam of the anus using a magnifier to look at the tissue more closely) and a biopsy (tissues are removed so they can be checked under a microscope for signs of cancer)
  • It is important to ask your health care provider to check for anal cancer on a regular basis

Treatment for Anal Dysplasia

If you have dysplasia, discuss treatment choices with your health care provider. Most treatments focus on destroying the abnormal cells so that they do not become cancer.

  • Infrafred coagulation: Using infrared light to cut off the blood supply to the cells and thereby kill them
  • Electrocautery: Burning off the cells with an electrical current
  • Laser therapy: Using an intense light to destroy the cells
  • Surgery: Using a surgical knife to cut out the cells
  • Cryotherapy: Freezing the cells with liquid nitrogen

Anal dysplasia is more common in HIV+ women than HIV-negative women, especially women with advanced HIV disease and low CD4 cell counts. Anal dysplasia is often more serious and difficult to treat in women living with HIV than HIV-negative women. For women living with HIV, taking HIV drugs can strengthen the immune system and help anal dysplasia become less severe. If you are already taking HIV drugs, it is important that you take them exactly as directed so that they can increase your CD4 count and fight the HPV that can cause anal cancer.

Treatment of Anal Cancer

Anal cancer is most treatable when it is diagnosed and treated early, so regular exams are extremely important. Treatment depends on the type of anal cancer and how far it has spread. Often, more than one kind of treatment is used. Treatments include:

  • Surgery: Cancer tissue is cut out in an operation
  • 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

For more information, see our article on Cancers.


Taking Care of Yourself

HPV can be very serious for people living with HIV. Since there are frequently no symptoms, getting regular exams from your health care provider is the best way to be sure that any problems are found and treated early.

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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 TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com 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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