INTRAEPITHELIAL AND INVASIVE CERVICAL NEOPLASIA DURING HIV-INFECTION

Patients affected by human immunodeficiency virus (HIV) infection pres ent an elevated risk of developing cancer. In the last 10 years, the r elationship between human papilloma virus (HPV) infection and female c ervical intra-epithelial neoplasia (CIN) has been established. Several studies have described an increased prevalence of both cervical HPV i nfection and CIN among HIV-positive women compared to HIV-negative one s. A high recurrence rate of CIN after standard treatment has been not ed in HIV-infected women and the severity of these lesions seems to be inversely correlated to immune function. Taking into account these da ta, the Centers for Disease Control (CDC) since 1993 have included inv asive cervical carcinoma among the AIDS-defining conditions. Once cerv ical cancer develops in HIV-positive women, the disease may be aggress ive and less responsive to treatment. A primary means by which HIV inf ection may influence the pathogenesis of HPV-associated cervical patho logy is by molecular interaction between HN and HPV genes. Although th ese have not been well defined, an upregulation of HPV E6 and E7 genes expression by HIV proteins (such as tat) has been postulated by some authors. Cervical cytology appears to be adequate as a screening tool for the cervical intra-epithelial neoplasia in HN-positive women, but the high recurrence rate and multifocality of this disease reinforces the need for careful evaluation and follow-up of the entire anogenital tract in these women. Probably in the next few years, cervical tumour s will represent one of the most frequent complications of HIV infecti on, a part of progression through AIDS. This points to a need for grea ter interdisciplinary co-operation for a best disease definition and f or the development of effective prevention measures. Copyright (C) 199 6 Elsevier Science Ltd