Pathogenesis, Diagnosis, and Management

Abstract

Recognition of a link between the human immunodeficiency virus (HIV) and cervical neoplasia has been a relatively recent occurrence in relation to the 15-year duration of the acquired immunodeficiency syndrome (AIDS) epidemic in the United States. This is due in part to the fact that relatively few women were diagnosed with AIDS in the early years. Only 7% of AIDS cases reported in 1985 were in women, as opposed to 18% of reported AIDS cases in 1994. Many women were initially identified as being infected with HIV only after giving birth to a child who subsequently developed AIDS. Recognition of the growing problem of perinatal transmission prompted the institution of maternal HIV screening programs in many cities. As testing of women for HIV became more accepted and widespread, clinical problems specific to women, including cervical neoplasia, became more apparent. By the late 1980s, clinicians were beginning to address the role of HIV infection in cervical neoplasia. In 1988, Maiman et a132 reported that greater than 10% of patients in a colposcopy clinic in Brooklyn were HIV infected, as opposed to approximately 2% of patients in an obstetric clinic serving the same population. Cherry and Robinson15 later had similar results, reporting the rate of HIV infection in an inner city colposcopy clinic in New Orleans to be 1.5%, approximately double the 0.8% rate seen in an adjacent obstetric clinic. In 1990, Maiman and reported a series of HIV-infected women with invasive cervical neoplasia. The cancer persisted or recurred in all HIV-infected patients despite therapy, with a mean time to recurrence of 1 month. All patients died of cervical cancer, with a mean survival of 10 months. As a result of these findings, the Centers for Disease Control (CDC) in 1993 added moderate and severe cervical dysplasia as a category B defining condition and invasive cervical cancer as a category C defining condition of AIDS. Thus, cervical cancer in an HIV-infected woman is now sufficient to diagnose AIDS