HIV-Positive Women Have Increased Risk of Genital Cancer

In the United States, about 110,000-155,000 women are affected with HIV-1, and this group of women is at increased risk of developing pre-invasive cervical lesions and invasive cervical cancer. A new report in Lancet (01.12.02, Vol. 359; No. 9301) suggests that they are also at risk of developing other types of cancer as well, including cancer of the vulva and anus.

Information about vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia in women infected with HIV-1 is needed to develop guidelines for clinical care. "The aim of the current study was to investigate the incidence of these lesions in HIV-1-positive and HIV-1-negative women and to examine risk factors for disease," the authors wrote.

In a prospective cohort study, 925 women had a gynecological examination twice yearly -- including colposcopy [inspection of vaginal and cervical cells] and tests for human papillomavirus DNA in cervicovaginal lavage -- for a median follow-up of 3.2 years. Researchers examined 481 HIV-positive women and 437 HIV-negative women who lived in the New York City area.

Initially, the investigators found that 6 percent of the HIV-positive women had genital warts or pre-cancerous lesions compared with only 1 percent of the uninfected women.

The researchers then followed the women without lesions and found that the HIV-positive women were 16 times more likely than HIV-negative women to develop pre-cancerous lesions during the next three years. Thirty-three women with HIV developed the lesions compared with two women without HIV. Overall, nine of the HIV-positive women (2 percent) later were diagnosed with invasive genital cancer. One of the nine was later diagnosed with invasive cancer of the anal region.

Dr. Thomas C. Wright, a researcher on the study, and his colleagues recommended that "as part of every gynecological examination, HIV-positive women should have a thorough inspection of the vulva and perianal region, and women with abnormalities . . . should undergo colposcopy and biopsy."

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