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Human Papilloma Virus (HPV) and HIV/AIDS

February 2013

Table of Contents


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).

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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:

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

Diagnosis

Treatment

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

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.


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

Diagnosis

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.

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:


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

Diagnosis

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.

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:


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.




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