Human immunodeficiency virus infection and invasive cervical carcinoma

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.

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 surgical pathologic 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.

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.