Human Papilloma Virus (HPV) and HIV/AIDS

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 done by using a Pap test (sometimes called a Pap smear). This test checks for changes in the cervix. 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 HIV+ women to have regular Pap tests. This is because HIV+ women are more likely to have abnormal Pap 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

Diagnosis

• HIV+ women should have a complete gynecological examination, including a Pap test and a pelvic exam, when they are first diagnosed and when they first seek prenatal care
• HIV+ women should have another Pap test six months later
• If both tests are normal, a repeat Pap smear should be done every year
• HIV+ women with symptoms or who have had dysplasia in the past should receive a Pap smear every six months until they have two normal tests in a row; then they can go back to tests every year
• An abnormal Pap test can indicate inflammation, infection, dysplasia, or cancer
• If you have an abnormal Pap, you may 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 Pap 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 pap test includes an HPV test.

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.

• Electrocautery: Burning off the cells with an electrical current
• Laser therapy: Using an intense light to destroy the cells
• Cold-knife cone biopsy: 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 Pap tests, and/or an HPV test

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

Treatment of Cervical Cancer

Cervical cancer is most treatable when it is diagnosed and treated early, so regular Pap 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

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

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.

• 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
• Infrafred coagulation: Using infrared light to cut off the blood supply to and thereby kill 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 Pap tests, and/or an HPV test

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 HIV+ women than HIV-negative women.

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

Taking Care of Yourself

HPV can be very serious for HIV+ people. 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.