Tulane University School of Medicine, New Orleans, LA
Ruth B. Hennebery , William R. Robinson
Background: HAART has been demonstrated effective at maintaining immunocompetence (as measured in part by CD4 levels) and reducing the occurrence and severity of cervical cancer in HIV-infected women. Conversely, rapid disease progression, poor treatment response and the development of multiple cancers has been associate with suboptimal HIV therapy and low CD4 counts. Methods: 17 HIV-infected women presenting to an inner-city, academic medical center from 1996-2016 were diagnosed with cervical cancer and at least one other HPV-associated cancer. Data recorded include: year of diagnosis and treatment for cervical cancer; the type, year of diagnosis and treatment of subsequent HPV-associated cancers; compliance with HAART and CD4 counts at diagnosis and death (if applicable). Results: 15/17 (88.2%) used HAART and had CD4 counts > 200 at cervical cancer diagnosis. The time from diagnosis of cervical cancer to a second HPV-associated cancer was 0-19 years, with 52.9% developing a second cancer within 3 years. Second cancer diagnoses included vulvar(9), vaginal(2), anal(3), oropharyngeal(1), urethral(1), and bladder/urethral(1). Seven patients developed third cancers: anal(3), oropharyngeal(3), vaginal(1). Conclusions: Despite the effective use of HAART, HIV-infected women appear to be at risk for the development of multiple cancers following a diagnosis of cervical cancer, even years to decades later. Screening for HPV-associated cancers (including oropharyngeal) should therefore be maintained and emphasized, even in highly compliant subjects with adequate CD4 levels.
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