S17.1 Cervical cancer prevention in hiv-infected women

Abstract

HIV-infected women are living longer and are at a higher risk of acquiring cervical cancer. More data comparing cervical cancer screening and treatment strategies in these women are urgently needed. WHO guidelines on optimal methods to screen and treat cervical cancer are available, but there are limited data to inform their potential modification for HIV-infected women. Even fewer data are available which compare the efficacy of treatment methods (loop electrosurgical excision procedure (LEEP) and cryotherapy) and differences in cervical disease recurrence between HIV-infected and HIV-uninfected women. HPV testing appears to be the most sensitive, although less specific for CIN-2+ detection than either VIA and cytology screening. Several studies of HIV-infected women have shown equivalent sensitivity of VIA and of cytology screening for CIN- 2+, although there is variation in results. Consistently across studies, the specificity of cytology appears higher than either VIA or for high-risk HPV testing. Two studies in South Africa and Kenya have suggested that the specificity of HPV testing and VIA for detection of high grade lesions is lower in HIVinfected women with lower CD4 counts; more research is needed to examine if screening test performance varies for HIVinfected women with higher versus lower CD4 counts. More research in HIV-infected women is needed to examine if LEEP and cryotherapy treatment methods are associated with differences in HIV-viral shedding and in HIV transmission during or shortly after treatment. HIV-infected adolescents have found to induce high-levels of neutralizing antibody titers following prophylactic HPV vaccination in bridging studies. Studies are not yet available on HPV vaccine efficacy in HIV infected women against either HPVinfection or clinical disease endpoints.