Introduction: Cancer is one of the leading causes of death in people with HIV/AIDS, due to behavioral choices and overlapping risk factors. The purpose of this report is to determine the long-term incidence of HPV-associated cancer in women with pre-invasive cervical neoplasia and compliance with medication and cancer screening recommendations.
Methods: HIV-infected women diagnosed with pre-invasive cervical neoplasia and an HPV-associated malignancy between 1995-2008 was identified from an inner-city gynecology clinic. Data collected includes: Demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, use of health navigators and compliance.
Results: 71 subjects were identified with HIV infection, cervical dysplasia and at least ten years’ follow up. 17/71 (24%) were identified with an HPV-related malignancy. The mean age of those diagnosed with HPV-related malignancy was 39 years. Malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Urethra/Bladder-2 and Oropharyngeal-3. Eight also had in situ neoplasms: Cervix-4, Vulva-3, and Oropharyngeal-1. Four subjects had 3 separate malignancies and two others had 2 malignancies. Compliance with HAART correlated strongly with immunocompetence, response to therapy, use of patient navigators and survival. 60/71 (84.5%) subjects underwent screening mammography, 57/71(80.3%) underwent colonoscopy, and 67/71 (94.3%) underwent Pap smear testing. Compliance with screening compared favorably with the general population and overall survival was similar.
Discussion/Conclusion: The long-term incidence and mortality from cancer in women with HIV and cervical dysplasia appears to be comparable to that seen in the general population, with the possible exception of oropharyngeal cancers. Compliance with cancer screening recommendations appears to be higher than in the general population. This suggests that structured primary care programs for HIV-infected women are effective in prevention/early diagnosis of cancer. Standardized screening programs for oropharyngeal cancers should be considered in this population.