Cervical and anal neoplasia and HPV infection in persons with HIV infection

Prolonged, severe immunodeficiency provides the necessary milieu for the emergence of anogenital neoplasia caused by human papillomaviruses. Cervical and anal neoplasia are likely to become more common manifestations of HIV disease as patients with profound immunodeficiency, who would have succumbed to opportunistic infections earlier in the epidemic, are now surviving for extended periods of time because of increasingly effective antiretroviral, prophylactic, and antimicrobial therapies. Cervical cancer in the setting of HIV infection appears to be a more aggressive disease, less likely to be successfully treated by standard therapies, and consequently associated with a poorer prognosis than in comparable non-HIV-infected women. Anecdotal observations suggest that anal cancer in HIV-infected persons may share these features. Strategies need to be developed for earlier detection and treatment of neoplasia and anogenital cancer in the setting of HIV-induced immunodeficiency.