Among women the 5 most common sites diagnosed were breast, colorectum, lung, cervix, and stomach cancer. Cervical cancer is the second most common cancer in women living in less developed regions with an estimated 445 000 new cases in 2012.
High-risk human papillomavirus (HPV) types causes cervical cancer. The HPV incidence rate and prevalence is higher (and worse) among people living with the human immunodeficiency virus (HIV).
Women are particularly at risk. In South Africa for example, recent research shows that in the 20 to 24 year age group, HIV incidence in women is three times higher than in men of that age, and within the 25 to 29 year age group, HIV prevalence amongst women is 28.%, whilst in men of the same age group it is 17.3%. Interestingly, peak HIV prevalence for females has now moved into the 30 to 34 year age group.
Professor at the University of Pretoria’s department of Obstetrics and Gynaecology, and head of the Gynaecologic Oncology Unit at Kalafong Provincial Tertiary Hospital, Leon Snyman stated that HIV positive women also tend to be infected with more and different HPV strains when compared to non-infected women. “This has to do with cellular immunity that is not working optimally in HIV infected women,” he explains.
“HIV suppresses immunity and this results in HIV positive women having more HPV types in their genital tracts.” He highlights that the important disease-causing process of HPV is about having persistent infection where the body does not clear up the initial infection.
“The HPV virus becomes part of the cells which then change into cancer cells. 15 years earlier, an HIV positive women is likely to get cervical cancer than an HIV negative women. They are more likely to be in an advanced stage and have a poorer prognosis. They also have higher incidences of abnormal cervical cytology smears (Pap smears), which requires treatment and extensive follow-up,” he says.
“Men can also contract HPV although the virus has not been studied as in-depth in men. HPV types causing disease in men are HPV 6 and 11, which cause genital warts. Certain HPV types are associated with penile cancer, but not on the same scale as cervical cancer in women. HPV is also currently being studied in men who have sex with men, as the HPV disease possibly causes some cases of anal cancer,” adds Snyman.
“The risk for women with a persistent infection with one of the high-risk HPV types is cervical cancer. Women get infected with HIV far more easily than men, putting them at far greater risk. Also, when taking into consideration some social issues, some women do not have much choice with regards to safe sex, placing these women at risk because of their partner's sexual contacts as well,” he continues.
Snyman advises women who are HIV positive to go for regular and more intensive follow-up and screening tests. “If you are HIV positive, you need to go on antiretroviral treatment (ART) as soon as indicated, and then practice a normal healthy lifestyle, including eating healthily, exercising, not smoking, and reducing risky sexual behaviour.
“If a woman is HIV infected and diagnosed with cervical cancer, she then has AIDS. HPV is a necessary cause for cervical cancer. This is because cervical cancer is an AIDS defining disease. The bottom line is, the risk of contracting cervical cancer is higher amongst HIV infected women, but we do not have the necessary accurate statistics. Many HIV infected women die from other diseases before they are diagnosed with cervical cancer,” he says.
The three most important risk factors for contracting HPV are starting sexual intercourse at a young age, having multiple sex partners, and smoking.
Knowing your HPV status is an important step in this process. A safe, less invasive option, the UDoHPVTest screens for the virus, is self-collected and does not involve the use of a speculum. An effective cervical cancer screening alternative to the Pap smear, this type of test offers 85 to 95 percent accuracy in detecting HPV.
“HPV and HIV are close friends as far as the one (HIV) creates an environment for the other (HPV) to infect people easier and to become a problem and a risk for cervical cancer. They both are foe as far as the patient is concerned.”