Reducing cervical cancer deaths among HIV-infected women

The link between cervical cancer and HIV infection was recognised in the early years of the AIDs epidemic. Women with HIV infection are more vulnerable to cervical cancer and pre-cancer because their immune system does not function effectively. There are changes in the immune system in the cervix (1) which allow the high risk Human Papilloma Virus (HPV), the virus that causes cervical cancer, to persist in the cervix.

In the developed world HIV-infected women are protected from cervical cancer both by receiving effective antiretroviral treatment for their HIV and also because they participate in effective cervical screening programmes. However women in the developing world are less fortunate. HIV infection rates remain high in sub-Saharan Africa, with women being particularly vulnerable as they do not always have control over their risk of sexual exposure. In addition, these countries have no effective screening system for cancer. More than half a million women are newly diagnosed with invasive cervical cancer globally each year, and in the same period more than a quarter of a million women die from the disease. In low-income regions of the world cervical cancer kills more women than any other malignancy.

A recent study took place in Zambia, where less than 5% of women are screened for cervical cancer, which looked at a screening method that combined visual inspection and same-visit treatment with cryotherapy, a technique that involves the freezing and killing of abnormal cells. This screening method has been shown to be safe, acceptable, and clinically effective in reducing the incidence of cervical cancer. The study’s lead author is Dr Groesbeck Parham, Professor of Gynaecologic Oncology and Infectious Diseases at the University of Alabama and Director of the Centre for Infectious Disease Research in Zambia’s Cervical Cancer Prevention Program. The research was published in the December issue of HIV Therapy.

Nurses undertook visual screening aided by digital photography and women with visible lesions were offered same-visit cryotherapy or were referred for further tests. Those with invasive cervical cancer were referred for surgery or radiation

The new study is the first to evaluate this approach in routine programme implementation settings in the developing world but there have been similar programmes in developing countries. A group from the Institute for Women’s Health at UCLH, led by Consultant Gynaecological Oncologist Dr Adeola Olaitan, ran a two year pilot using the same method as the Zambian study that showed that the screening method was acceptable to women and cost effective. Dr Olaitan states of the new study: “The intervention in Zambia (2) which showed that a simple screening test, coupled with treatment of screen-positive women is effective in reducing cervical cancer risk is most encouraging. The authors of the study estimate that one cervical cancer was prevented in approximately every 46 women screened. However, small limited interventions are unlikely to have a sustained impact on cervical cancer rates in countries with a high HIV burden and attention and resources should be focused on providing structured screening accessible to all the at risk population.”

1. Olaitan A et al. The Cytokine Microenvironment of the Cervical Mucosa. Clinical & Experimental Immunology 1998; 112(1):100-4
2. Parham G. Cervical cancer prevention in HIV-infected women in resource-limited settings. HIV Therapy 2010; Vol. 4, No. 6, Pages 625-628

The full article is available at http://www.futuremedicine.com/toc/hiv/4/6.

To read more information on the diagnosis and treatment of cervical cancer please click here.