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HIV Women at Risk For Rare Vulva Cancer

Researchers urge gynecologists to track AIDS sufferers closely

WEDNESDAY, Jan. 16, 2002 (HealthDayNews) -- When it comes to medical problems, women with HIV already have plenty of worries. Now, they have another disease to guard against -- a rare type of cancer that attacks the vulva.

"Vulvar cancer is probably going to become a significant condition in the HIV-infected population as these women live longer," warns Dr. Tom Wright, a pathologist at Columbia University and co-author of a new study that looked at the gynecological risks facing female AIDS sufferers.

Doctors have suspected for some time those women with AIDS are more vulnerable to some types of cancer, "but no one has a really good idea about how much disease there was in the cervix," he says.

Wright and colleagues studied 925 women who received twice-yearly gynecological exams that included testing for human papilloma virus, better known as HPV, and inspection of vaginal and cervical cells for signs of cancer.

The findings appeared in last week's issue of The Lancet.

During their initial exam, doctors found pre-cancerous growths in 6 percent of the 481 HIV-positive women, compared to just 1 percent of the 437 who were HIV-negative. In later exams, the HIV-positive women were 16 times more likely to develop pre-cancerous lesions in the vulva, vagina and the area between the genitals and anus.

The lesions put the women at a much higher risk for cervical cancer and vulvar cancer, which is rare, Wright notes.

Almost 155,000 American women are infected with HIV, which causes AIDS. The problem is especially large in prisons, where the rate of HIV infection is higher among women than men.

Doctors aren't sure why women with HIV are prone to gynecological problems. One theory suggests they have high levels of sexual activity, which can lead to more transmission of HPV, which can cause cancer, Wright says.

Others blame AIDS itself, which reduces the body's ability to fight off diseases. Problems begin "when you remove the immune system, which is normally keeping the HPV infection in check," Wright says.

Regardless of the cause of the increased risk, doctors need to make sure they take extra time to examine HIV-positive women, Wright says. Pap smears, which detect cervical cancer, aren't enough.

"Everybody knows about cervical cancer. They're all geared up to screen patients and work them up, but (vulvar cancer) is a new thing," he says.

Dr. Michael Horberg, a Kaiser Permanente Health Plan physician who treats AIDS patients in Santa Clara, Calif., agrees doctors need to take these risks seriously.

"Doctors need to be more aware," he says. "It's very important that women with HIV be regularly evaluated."

Wright suggests that HIV-positive women receive two Pap smears within the first six months after their infection is diagnosed, and then get one each year.

Experts generally recommend that HIV-negative women get a Pap smear every year or two.

What To Do

Learn more about vulvar cancer from the National Cancer Institute.

Read the latest on women and AIDS from The Body.com, which provides AIDS information.

SOURCES: Interviews with Tom Wright, M.D., director, gynecological pathology services, Columbia University, New York City; Michael Horberg, M.D., medical director, HIV services-Santa Clara, and chairman, Northern California Pharmacy and Therapeutics Committee, Kaiser Permanente Health Plan, Santa Clara, Calif.; Jan. 12, 2002, The Lancet
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