Women & HIV: Invasive Cervical Cancer Risk
A large study with data gathered from 18 cohorts around the U.S. suggests that raising HIV-positive women’s CD4 cell counts and increasing access to sexual/reproductive health screenings could lower the risk for invasive cancer of the cervix, the part of a woman’s reproductive system that connects the uterus (or womb) to the vagina.
(Invasive cervical cancer is preventable. There are even vaccines against some forms of the virus that causes it! Don’t miss the “Resources” section below to learn more and protect yourself.)
The study included 13,690 number of HIV-positive and 12,021 HIV-negative women. According to the report, published online ahead of print in the Journal of Acquired Immune Deficiency Syndromes, ICC was newly diagnosed in 17 women with HIV but in only four HIV-negative women. HIV-positive women who started the study with a CD4 cell count below 200 cells/mL (indicating declining immune health) had nearly eight times the risk for ICC compared with HIV-negative women.
Risk for ICC went down as CD4 counts went up: Compared with their HIV-negative counterparts, HIV-positive women with a CD4 count between 200 and 349 cells/mL had a three-fold greater risk, while women with a CD4 count above 350 cells/mL had just over twice the risk.
Invasive cervical cancer stems from infection with the human papillomavirus (HPV), a very common sexually transmitted virus that, the study authors note, appears even more frequently in women with HIV—particularly those with more suppressed immune systems. Regular “Pap smears” or Pap tests look for the abnormal cell changes and cervical cancer caused by HPV and are part of standard gynecological care for all women, regardless of their HIV status.
Are many HIV-positive women missing out on this critical screening? Possibly, this study suggests: Six of the 17 new ICC cases occurred in women who had apparently not had a Pap test within the five years leading up their cervical cancer diagnosis. “Some of these women may not have been engaged in regular care, or some may have been receiving HIV specialty care only,” the authors speculate.
Along with addressing barriers to cervical cancer screening, “the data from this large prospective study of ICC in HIV-infected women suggest that maintaining CD4 at higher counts could lower ICC risk,” the researchers conclude.
Use these online tools to learn more about cervical cancer and HPV and take care of your own sexual and reproductive health. And remember, your own medical provider should be able to answer questions about HPV, cervical cancer, and recommended screenings and vaccinations.
- Making Sense of Your Pap and HPV Test Results: An informative, user-friendly page from the Center for Disease Control and Prevention (CDC).
- Caring for a Woman’s Body: The Well Project’s guide to gynecological health for women with HIV.
- HPV Vaccine—Questions and Answers: Another informative page from the CDC that addresses vaccination for HIV-positive men who have sex with me (but see below for information related to HIV-positive women).
- HIV-Positive Women May Benefit From HPV Vaccine: From AIDSmeds.com, a quick look at one study supporting HPV vaccination for women with HIV. (Again, talk with your own medical provider if you have questions about getting vaccinated.)
- AAHIVM Referral Link: This “finder” from the American Academy of HIV Medicine includes a “GYN” checkbox to narrow your search to gynecological care providers.
Reilly O’Neal is the editor of BETA.
Abraham, A. and others. Invasive cervical cancer risk among HIV-infected women: A North American multi-cohort collaboration prospective study. Journal of Acquired Immune Deficiency Syndromes (ePub ahead of print). January 2013.