HIV/AIDS and Cervical Cancer

Precancerous cervical lesions are the precursors of cervical cancer and infection by the human papillomavirus (HPV) is the most important risk factor for its development. Cervical cancer, one of the most common gynecologic cancers worldwide, is also officially considered an AIDS-defining illness.

The cervix is located at the bottom of the uterus (or matrix)

HPV can cause warts (small, outgoing and hard lumps that grow in groups, can be felt with the finger and are visible to the naked eye), which are formed in or around the vagina or anus. These warts are also called condylomata acuminata or genital warts. Genital warts rarely develop into cancer, but their presence may mean that there is also precancerous dysplasia, which requires a specific analysis.

What are precancerous cervical lesions?

They are the most important and common gynecological manifestations in women living with HIV. They are in the form of so-called squamous intraepithelial lesions or cervical intraepithelial neoplasia (CIN). These lesions are divided into low-grade CIN or (CIN-I) or high-grade CIN (CIN II or III). The degree of dysplasia is defined by the thickness of abnormal cells within the cervical wall.

Precancerous lesions of the cervix also called cervical dysplasia and involve the presence of abnormal cells in the cervix.

In seronegative women, precancerous cervical lesions are cured in most cases after treatment. However, women living with HIV have less successful treatment and have particularly high rates of recurrence of these lesions. Recurrence or persistence of precancerous cervical lesions is closely related to the degree of immunosuppression.

Not all women with precancerous cervical lesions will develop cervical cancer. Many low-grade CIN lesions (CIN I) are self-limiting and do not require treatment.

What is cervical cancer?

The invasive carcinoma of the cervix or cervical cancer, unlike precancerous lesions, produces clinical symptoms and is often presented in the form of a neck, extended or mass to adjacent structures. The presence of inguinal lymphadenopathy (swollen glands) and edema (swelling from fluid accumulation), usually in the legs, indicating that the disease has spread (metastasized).

In women with HIV infection, metastases (ie cancer has invaded other body parts) occur more frequently and rapidly than in seronegative women and leap from unusual regions.

What is the cause?

The cervical infection with human papillomavirus (HPV) is the most important risk factor in the development of precancerous lesions and cervical cancer associated with oncogenic subtypes (which can cause cancer) of HPV.

The human papillomavirus (HPV) is the name that refers to a family of viruses that includes more than 100 subtypes of which over 30 are sexually transmitted. Some of these subtypes cause genital and anal warts, other (16, 18, 31, 33) can cause cervical cancer in women and anal cancer in both sexes.

What are the symptoms of precancerous cervical lesions?

Precancerous cervical lesions generally do not result in noticeable symptoms.

What are the symptoms of cervical cancer?

Invasive cervical carcinoma unlike precancerous lesions, resulting in clinical symptoms (visible). The most common symptoms of cervical cancer include vaginal bleeding intermittently, bleeding during intercourse and increased smelly vaginal discharge. Other symptoms that are more often associated with an advanced cervical cancer are pelvic pain (in the lower stomach area), pain in the lower back or lower extremities, and changes in urination and bowel movements.

How precancerous cervical lesions and cervical cancer diagnosed?

A blood test is sufficient to determine whether a person is infected with HPV. However, the presence of HPV does not mean a person will develop precancerous lesions or cervical cancer.

According to official recommendations, women with HIV should have cervical cytology (Pap smear) every six months after diagnosis and annually, once they have won two consecutive negative results. Despite these recommendations, many physicians recommend doing a Pap smear every six months due to the high number of false negative cytology found in women with HIV infection.

Cytology involves taking a sample from the cervix and examined under a microscope.

The presence of sexually transmitted diseases (STDs) produces alterations in the surface of cells of the cervical mucus and/or inflammation of the mucosa which can lead to false negative cytology, hiding the presence of precancerous lesions. Should abnormal cytology detected, other tests (colposcopy, biopsies, detailed anogenital examination) are performed to determine the presence of cervical cancer.

Sources

1- Invasive cervical cancer risk among HIV-infected women “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633634/

2- Cervical Cancer: Symptoms, Pictures & Diagnosis “http://www.drjenniferashton.com/cervical-cancer-symptoms-pictures/