In addition to the various burdens that arise with an HIV diagnosis, women with HIV also have a higher risk of developing cervical cancer and dying of the cancer, according to a recent study.
Approximately 274,000 of the half million women who develop cervical cancer annually will die from the disease, and 85 percent of these deaths will occur in women in the developing world. Cervical cancer is the second most common cancer in women, globally, and it accounts for 13 percent of all female cancers.
It has been known for a while in the medical community that women living with HIV have been found to be eight times more likely to develop invasive cervical cancers, and that cervical cancer is an AIDS-defining illness. Women with lower CD4 counts and weakened immune systems from HIV infection are more likely to develop the cervical abnormalities that are associated with cervical cancer.
Now, according to a new study published in the journal of clinical oncology, it has been shown that HIV-positive women not only have a higher risk of developing the cancer, but they are at two times the risk of dying from cervical cancer than their HIV-negative counterparts. Even patients who had consistent use of antiretroviral treatment still had a higher risk of developing and dying from cervical cancer.
The researchers of the study note that while the introduction of highly active antiretroviral treatment (HAART) has reduced the incidence of some of the associated cancer types, the incidence of cervical cancer has not declined.
In Botswana, where the study was conducted, there have been remarkable declines in HIV-associated mortality, but the incidence of cervical cancer remains among the highest in the world —with nearly two thirds of all cases occurring in women with HIV infection.
Some evidence suggests that cervical cancer may be more aggressive in HIV-infected women, who are more likely to present an advanced stage of the disease and have a poorer response to treatment.
“Because the majority of the disease burden is seen in low- and middle-income countries, where this both high prevalence of cervical cancer as well as high prevalence of HIV infection, it is paramount that we increase our understanding of the impact of concurrent HIV on cervical cancer,” the authors of the study note.
The high death rate did not appear to stem from the HIV infection itself, but from health complications that arose with the cancer. Researchers noted that cancer progressed faster and earlier in HIV-positive women, which could explain the high mortality rate.
However, the high mortality rate could also be explained by the fact that women in Botswana struggled to receive the necessary cancer treatments. In sub-Saharan Africa, it can be difficult to get access to optimal cancer care for both HIV-infected and non-HIV-infected patients alike.
Even though most patients (82.9%) were considered candidates for potentially curative therapy, only 62 percent completed the planned brachytherapy regimen and only 81 percent received at least one dose of cisplatin, which are both considered necessary treatments for those who have cancer.
“It appears HIV-positive women in Kenya are not losing their lives or suffering health complications due to HIV, thanks to antiretroviral treatment,” said Doctor Fredrick Kairithia. “Instead, it is cervical cancer that is hitting them really hard, and urgent action is needed to save them.”
There is also a link between HIV, HPV and cervical cancer that needs to be further explored. In some women, an HPV infection causes changes in the cells and these abnormal cells can in turn lead to cervical cancer. The malignancies associated with human papillomavirus (HPV) have a high rate of occurrence in HIV-infected individuals, according to Linda R. Mileshkin, who wrote an accompanying editorial to the study.
“The link among HPV, HIV, and cervical cancer is becoming better understood and attributed to enhanced HPV carcinogenesis in the setting of HIV-related infections,” writes Dr. Linda Mileshkin.
HIV-infected individuals are at higher risk of HPV infection and are infected by a broader range of HPV types. Even though two vaccines are now becoming available that can protect against HPV infection, HIV has been shown to impair the effectiveness of vaccination when it comes to HPV.
“The health community is failing women in a crucial way,” noted researcher May Maloba. “It has neglected prevention, screening and treatment for cervical cancer among the highest risk population, HIV-positive women in low-income countries.”
Cervical cancer can only be identified by screening, either using a PAP smear or by applying acetic acid or iodine solution to the cervix, which is why it is crucial for HIV-positive women to be screened for HIV early and often.
Author: ALEX KOPEL