There is an increased risk in patients infected with the human immunodeficiency virus (HIV) to he also infected with the human papillomavirus (HPV). Type of HPV is the same in patients infected -or not- by the HIV (in patients with the same criteria of HIV infection). However, there is a higher rate of persistent HPV infections in HIV+ patients, especially with oncogenic virus subtypes. Persistence of high-risk virus is necessary for the development of dysplasic lesions: therefore, there is a higher incidence of cervical intra-epithelial neoplasias (CIN) and cervical cancers in HIV+ patients. In 1993, the Centers of Disease Control (CDC) designated invasive cervical carcinoma as a defining condition of AIDS. After conservative treatment in CIN, the recurrence rate is higher, together with a high rate of positive margins. It may he of some interest to perform a medical treatment, in association with the dysplasia surgical procedure. Invasive cancers have a worse pronostic than in HIV- patients, due to the specific aggressiveness of cervical carcinomas in seropositive patients. Standard treatment consists in surgery and radiotherapy with or without cisplatin chemotherapy, depending on the stage. This treatment is modulated according to CD4 rate. Antiviral treatment and infectious prophylaxis have to be reinforced. A special care will be required for radiotherapy technical execution and clinical (digestive) and hematological follow-up through out the treatment.
Copyright John Libbey Eurotext 2003.