HIV & HPV: What Happens When 2 Bad Guys Crash The Party

    Microscopic view of an hpv virusWe started out a couple articles ago with the theme of HIV as a party virus.  By this we mean that HIV likes to hang out with all sorts of other disease causing viruses, bacteria and other organisms.

    Because HIV is sexually-transmitted, we should not be surprised that HIV patients often have other sexually transmitted infections.  But sometimes, the relationships are even greater. This means that while we are managing HIV, we also have to be checking to see if any of its “friends” have come along for the “party” so we can deal with them appropriately. HIV’s friends can cause many problems, for example, we have discussed how Hepatitis B and Hepatitis C viruses can cause cirrhosis and liver cancer: bad news!

    What is HPV?

    One of HIV’s favorite party companions is the Human Papilloma Virus, often abbreviated HPV. There are lots of different strains of HPV and they are commonly found in both men and women.  Most strains of HPV don’t cause any serious problems, but a few strains do cause disease. A couple strains are known to be responsible for causing cervical cancer and also cancer of the anus. A couple of different strains cause genital warts.  Genital warts look like crusty clusters that can appear on the penis, the labia, vulva or anus.

    Sometimes they can get quite large looking like miniature clusters of grapes, or even having a cauliflower-like appearance. Not surprisingly, this virus that causes problems in the anal/genital area is mainly sexually transmitted. It also may be the cause of other types of cancers in different parts of the body.

    When HIV and HPV party together, this usually means trouble. Since both viruses are sexually transmitted, they are commonly found together. But because HIV impairs the immune system, the body can’t fight off the dangerous strains of HPV as easily. So while cervical cancer, anal cancer and genital warts occur in the general population, they are all more common in HIV infected persons, and often are worse in persons with advanced HIV disease.

    Screening

    There is a test that can detect whether a person is infected with HPV and whether than strain is dangerous or not. Your doctor can do this test.

    Cervical cancer

    Early in the HIV epidemic in the US (1980’s) we didn’t know a lot about how HIV affected women.  Most cancers take years to develop, and since there weren’t effective treatments for HIV, people died from HIV before cancers could develop.

    Also, many doctors only viewed HIV as a disease of white gay men and simply weren’t looking for HIV infection in women, especially black women.  It took quite a while for the link between HIV infection and cervical cancer to be worked out, and many women likely died of cervical cancer without ever knowing they were HIV-infected.  In 1993, the presence of cervical cancer in a woman with HIV-infection was considered a diagnosis of AIDS, the advanced stage of HIV-infection.

    Years ago, a procedure was developed designed to detect cervical cancer early so that it could be treated before progressing to a more dangerous form of cancer.  This test, called a Pap smear involves collecting cells from the opening of the cervix using a special swab.  The cells are spread onto a slide and viewed under a microscope by a technician or medical provider trained to recognize abnormal cells.  If abnormal cells are detected, this could be a sign that there are changes taking place in the cervix that could lead to cancer.  A medical provider can then view the cervix using a special instrument (a colposcope) to see if there are cancerous areas, and then treat them.  By having regular Pap smears in women, medical providers could detect cancers early and treat them.  This procedure has saved millions of women’s lives and proven to be an effective screening method.

    Screening in HIV-infected patients

    Because HIV changes the immune system, cancer could develop earlier and more aggressively than in women without HIV-infection.  Women newly diagnosed with HIV should receive a Pap smear soon after the diagnosis and then, about 6 months later.  After the first year, they should receive a pap smear every year.

    Anal cancers

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