Cervical cancer in patients infected with the human immunodeficiency virus

Abstract

BACKGROUND. The objective of this study was to compare the human immunodeficiency virus (HIV) viral load (VL) and CD4 counts in patients infected with HIV with and without cervical cancer. The authors hypothesized that HIV-positive women with cervical cancer would have a greater risk of immune suppression. METHODS. A case-control study was conducted that included all HIV-positive patients who were seen at the authors' institution from January 1, 1995 to April 20, 2006 with invasive cervical cancer (cases) and without invasive cervical cancer (controls). Patients were included only if they had a CD4 count recorded <6 months before or <3 months after their diagnosis of invasive cervical cancer (cases) or at their last gynecologic examination (controls). Controls were matched to cases on a 4:1 ratio according to current smoking history. Patients were considered immunocompetent if they had both a CD4 count >200 cells/μL and a VL <10,000 copies/mL. RESULTS. In total, 15 cases and 60 controls were identified. The median CD4 count for cases was 208 cells/μL (range, 18-1102 cells/μL) compared with 445 cells/μL (range, 20-1201 cells/μL) for controls (P = .03). The median VL was 16,918 copies/mL (range, 50-214,915 copies/mL) for cases compared with 1430 copies/mL (range, 50-571,000 copies/mL) for controls (P = .15). Only 1 of 14 cases (7%) was immunocompetent compared with 35 of 55 controls (64%; odds ratio, 0.04; 95% confidence interval, 0-0.37; P < .001). This significance was maintained after adjusting for other factors (P = .002). CONCLUSIONS. Women with HIV who were diagnosed with invasive cervical cancer appeared to have a much greater degree of immunosuppression than women with HIV without invasive cervical cancer. © 2008 American Cancer Society.