A study in this week’s issue of THE LANCET suggests that women who are HIV-1 positive are at an increased risk of invasive genital cancer. Authors of the study recommend that gynaecological examination of these women should include examination of the vulva and perianal region to identify genital warts, which can lead to the development of invasive cancer cells.
An estimated 110,000-155,000 women in the USA are infected with HIV-1. Previous research has highlighted HIV-1 infection as a risk factor for cervical cancer; other research suggests that human papillomavirus (HPV) infection increases the risk of genital cancer. Information about vulvovaginal and perianal condylomata acuminata (genital warts) and intraepithelial cancer cells in women infected with HIV-1 is needed to develop guidelines for clinical care. Tom Wright and colleagues from Columbia University, New York, USA, investigated the incidence of these lesions in HIV-1-positive and HIV-1-negative women and assessed the risk factors for potential cancer progression.
In a prospective population study, 925 women had a gynaecological examination twice yearly with an average follow-up of around three years. Examination included colposcopy (inspection of vaginal and cervical cells) and testing for HPV.
At the initial examination, vulvovaginal and perianal condylomata acuminata or intraepithelial neoplasia were more commonly found in women with HIV-1 infection than uninfected women (6% compared with 1%). During subsequent follow-up, HIV-1-positive women were 16 times more likely to develop vulvovaginal or perianal lesions than HIV-1-negative women. Other risk factors identified for lesions included HPV infection, lower CD4 lymphocyte count, and a history of frequent drug injection.
Tom Wright comments: “Our findings are important for clinicians who provide care for HIV-1-positive women. The unexpectedly large number of cases of high-grade vulvar and perianal intraepithelial neoplasia recorded in this study suggests that HIV-1-positive women are at increased risk of invasive vulvar and perianal carcinoma. As a result, we recommend that during gynaecological examination, HIV-1-positive women should have a thorough inspection of the vulva and perianal region. Women with any degree of abnormality, except for typical, exophytic genital warts, should be referred for colposcopy and biopsy, so that pre-invasive or invasive disease can be ruled out.”
Contact: Dr Tom Wright, Department of Pathology, Room 16-402, College of Physicians and Surgeons of Columbia University, 630 W 168th St, New York NY 10032, USA; T) +1 212 305 1993; F)+1 212 305 1295; E) tcw1@columbia.edu
Journal
The Lancet