Human Papilloma Virus (HPV) and HIV/AIDS

Table of Contents

• What is HPV?
• Prevention of HPV
• Genital Warts
• Cervical Dysplasia and Cervical Cancer
• Anal Dysplasia and Anal Cancer
• Taking Care of Yourself

What Is HPV?

Human papillomavirus (HPV) is the name of a large group of viruses. Certain types of HPV can cause warts on the hands or feet. About 30 to 40 types can cause infections in the genital area (the vulva, vagina, penis, buttocks, scrotum, and anus).

Genital HPV types are often grouped as "low risk" or "high risk." Low-risk types can cause genital warts. High-risk types can cause cervical cancer or cancer of the vulva, vagina, anus, and penis. The types of HPV that can cause genital warts are not the same as the types that can cause cancer. However, if you have warts, you may have also been exposed to the types of HPV that can cause cancer.

Genital HPV is the most common sexually transmitted disease (STD) in the US. Over half of all sexually active men and women become infected with HPV at some time in their lives. Genital HPV is spread easily through skin-to-skin contact during vaginal or anal sex with someone who has the infection. Condoms and other latex barriers do not totally prevent transmission. Most people with HPV do not know they have it because they do not develop symptoms, yet they can still pass it on to someone else.

Nine times out of ten, the body's immune system clears HPV infection naturally (without treatment) within two years. Because HIV weakens the immune system, people living with HIV (HIV+ people) are more likely to be infected with HPV than HIV-negative people. One study found HPV in more than three out of four HIV+ women. HIV+ women with HPV are also more likely to have:

• Difficulty clearing the infection naturally
• HPV infections that were once under control and come back again
• HPV that responds poorly to standard treatment; multiple therapies using different methods may be needed
• Several types or strains of HPV at once
• Infection with the "high risk" HPV types that can cause cancer
• Higher risk of developing cervical and anal cancer when infected with the "high risk" types

If you have sex, it is important to be checked regularly by your health care provider for signs of HPV such as genital warts or cervical and anal cancer (see Routine Screenings below).

Prevention of HPV

Vaccines

There are two US Food and Drug Administration (FDA)-approved HPV vaccines: Gardasil and Cervarix. Gardasil is approved for females and males ages 9 to 26. Cervarix is approved for females ages 10 to 25. Both vaccines protect against types of HPV that cause the majority of cervical cancers and genital warts. A recent study also showed that Cervarix provides strong protection against HPV-related anal cancer in women. The vaccines do not protect against less common HPV types. Therefore, health care providers still recommend regular Pap tests to look for signs of cancer.

It is best if young people get the vaccine before their first sexual contact (before they have been exposed to HPV). People who are infected with some types of HPV may still benefit from the vaccine's effects against other types of HPV. The US Centers for Disease Control and Prevention (CDC) recommends HPV vaccines for all girls and young women ages 11 through 26 (even if they have already become sexually active). Pregnant women should not receive the vaccine, although it is safe to get the vaccine while breastfeeding. Speak to your health care provider about the HPV vaccine to see if it is right for you.

There are payment assistance programs for people who cannot afford the HPV vaccines; see the resource section of this sheet for contact information.

Routine Screenings

Regular pelvic and anal exams and Pap tests are very important. While they cannot prevent HPV-related problems, they can help catch warts and dysplasia (abnormal or pre-cancerous cells) before they get worse and cause greater problems.

Studies have shown that, although HIV+ women are at an increased risk for cervical cancer, nearly one in four HIV+ women in the US did not get their recommended yearly Pap tests. It is very important that HIV+ women get routine Pap testing and follow up as needed to identify problems before cancer develops. Prevention is always better -- healthier, less painful, and less costly -- than treatment.

Condoms

Even though condoms do not fully protect against HPV, when used correctly they can help reduce the chances that HPV will be spread.

Not Smoking

Smoking has been shown to increase the chance of developing several types of cancer including cervical and anal cancers. If you smoke, it is a good idea to try and quit. Talk with your health care provider about stopping smoking -- there are many tools to help you quit. You can also find lots of information and support online (www.smokefree.gov/).

Genital Warts

Certain types of HPV can cause warts on the vulva, in or around the vagina or anus, or on the penis, scrotum, groin, or thigh. Warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. They can even appear years after exposure.

Symptoms

• Flesh-colored, pinkish, or white warts that appear as small bumps or groups of bumps. They can be raised or flat, different sizes, and are sometimes shaped like cauliflower.

Diagnosis

• Health care providers can usually identify genital warts by looking at them
• Sometimes a biopsy is done (a sample of the suspected wart is cut off and examined under a microscope)
• Some health care providers may use a vinegar solution to help identify flat warts, however, this test may sometimes wrongly identify normal skin as a wart

Treatment

There is no cure for HPV, but genital warts can be treated by removing the wart.

• The following treatments must be done in a health care provider's office:
  • TCA (trichloracetic acid): A chemical is applied to the surface of the wart
  • Cryotherapy: Freezing off the wart with liquid nitrogen
  • Electrocautery: Burning off the wart with an electrical current
  • Laser therapy: Using an intense light to destroy the wart
  • Excision: Cutting out the wart
• Some treatments can be done at home with prescription creams: Aldara or Beselna (imiquimod), Condylox (podofilox or podophyllotoxin), and Veregen (sinecatechins, or green tea extracts). Because Aldara and Beselna act on the immune system, it is important to talk with your health care provider about the best prescription wart treatment for you if you are HIV+.
• Do not use over-the-counter wart removal products to treat genital warts
• Some wart treatments should not be used by pregnant women or women who are breastfeeding
• Warts can reappear after successful treatment

If left untreated, genital warts may go away, remain unchanged, or increase in size or number. Some people decide not to have treatment right away to see if the warts will go away on their own. When considering treatment options, you and your health care provider may take into account the size, location and number of warts, changes in the warts, your preference, and the side effects of treatment.

Many HIV+ women, especially those with low CD4 cell counts, may not be able to get rid of genital warts using standard treatments. Several different treatments may be needed.