Human immunodeficiency virus infection and invasive cervical carcinoma

Abstract

Background and Methods. To determine the relationship between cervical cancer and human immunodeficiency virus (HIV) infection, 84 women of known HIV status with invasive cervical carcinoma were assessed. Sixteen of 84 patients (19%) were HIV seropositive. The disease characteristics, recurrence rates, survival rates, and immune status of 16 seropositive and 68 seronegative women were compared. Results. HIV‐infected women with cervical cancer had significantly more advanced disease than those who were not infected with the virus. Only 1 of 16 (6%) HIV‐infected women had early‐stage surgicalpathologic disease compared with 40% in the HIV‐negative group. The response to therapy and prognosis were poorer among HIV‐infected women, with higher recurrence and death rates compared with uninfected women. The mean CD4 counts, CD4:CD8 ratios, and percentage of CD4 cells were 360/mm3, 0.57, and 26.8% in HIV‐infected women compared with 830/mm3, 1.71, and 41.2% in HIV‐negative group. The patient's immune status had a significant impact on subsequent disease because only seropositive patients with CD4 counts greater than 500/mm3 had prolonged or disease‐free follow‐up. Surgery was performed safely in patients with relatively good immune function. Conclusions. HIV‐infected women represent a unique subset of patients with cervical carcinoma that have more aggressive disease and a poorer prognosis. However, positive serostatus alone does not uniformly confer an unfavorable outcome because patients with initial adequate immune status may do well. HIV testing is recommended in all relatively young women with cervical cancer, and unique therapeutic strategies are advocated in women with these two potentially fatal diseases.

Interleukin 1α and interleukin 6 promote the in vitro growth of both normal and neoplastic human cervical epithelial cells

“…HIV-infected women form a unique subset of cervical carcinoma patients with more aggressive disease and a poorer prognosis (Maiman et al, 1990(Maiman et al, , 1993. This aggressiveness could be, at least, partly dependent on abnormal IL-6 production.…”

Differences in MHC and TAP-1 expression in cervical cancer lymph node metastases as compared with the primary tumours

“…This viral protein has been shown to be immunogenic in vitro (Chen et al, 1991), and immunisation with HPV 16-E7-derived peptide resulted in a protective CTL response in mice (Feltkamp et al, 1993). Therefore the loss of class I MHC surface expression observed in HPVpositive neoplastic cervical cells (Connor & Stern, 1990;Cromme et al, 1993a) (Sillman & Sedlis, 1987) and the significantly shorter disease-free survival of HIV-seropositive cervical cancer patients (Maiman et al, 1993).…”

A pilot study of two radiation fractionation regimens in patients with cancer of the cervix, who were HIV positive and not on antiretroviral therapy

“…Innovative therapeutic modalities need to be investigated, as no clear guidelines are defined for the management of women who are HIV positive with advanced carcinoma of the cervix in developing countries. 18 Thus, shortened fractionation was considered by our department because of resource constraints. The rationale was that a shortened course of treatment to control symptoms and bleeding would suffice in patients who were affected by AIDS.…”