15th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 3-6, 2008

Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 5)

Silvia Franceschi
Intl Agency for Res on Cancer, Lyon, France

BACKGROUND: Women living with HIV have a much higher risk of human papillomavirus (HPV) infection and cervical cancer than HIV-uninfected women, and therefore it is essential that they are included in high-quality cervical cancer screening programs. Unfortunately, this is not always the case. The reasons for inadequate screening coverage of women living with HIV in some high-resource countries (e.g., southern Europe) seem to be mainly organizational (i.e., difficulties in combining routine follow-up of markers for HIV infection with gynecological examination, which is generally performed elsewhere). Before the introduction of ART, the lack of cervical cancer screening probably had little influence on their life expectancy because of high competing mortality from other causes, but the situation is changing rapidly worldwide. In sub-Saharan Africa, for instance, approximately 400,000 HIV+ women were receiving ART in 2005. Funds given to ART programs in low-resource countries support not only the purchase of drugs, but also the development of clinical infrastructures and laboratory support. As we are still waiting for universal HPV vaccination strategies, the prevention of avoidable deaths from cervical cancer depends on early cancer diagnosis. However, the optimal methods for cervical cancer screening in low-resource countries, particularly among HIV+women, remain to be determined. Good cytological screening programs have been difficult to implement, whereas visual inspection after application of acetic acid or Lugol’s iodine is cheap, but highly dependent on the training and skills of those performing it.

CONCLUSIONS: Screening for high-risk HPV types would have several advantages over other types of screening: it is more sensitive for high-grade cervical lesions and much less dependent on the quality of the sample, and human judgement than cytology and visual inspection. Importantly, a cheaper reconfiguration of Hybrid Capture™ 2 is in the pipeline. The choice of the cut-off sensitivity of the HPV test is in general very important in screening programs to avoid over-treatment of women with low viral load infections that are probably harmless. This choice is, however, especially difficult among HIV+ women, in whom as much as 85% prevalence of carcinogenic HPV types have been reported.

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2008-02-03
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