Health Maintenance Key Considerations

  • Women's health concerns and screening needs differ from men.
  • Non-AIDS defining cancers are increasing in incidence for both males and females living with HIV.1
  • Overall cancer risk for PLWHIV is elevated, with estimates placing risk at about twice the risk as the general population.1 This increase may be partially due to a high prevalence of cancer risk factors in PLWHIV, including:
    • Smoking
    • Alcohol consumption
    • Human papilloma virus (HPV) infection
    • Hepatitis C virus (HCV) infection, see also myHIVclinic's section on Hepatitis
  • There are limited cancer screening guidelines for PLWHIV. Due to a lack of primary data, many of the available guidelines and expert opinions are based upon extrapolations from data on the general population.1
  • Persistent infection with human papilloma virus (HPV) is necessary for the development of cervical cancer and precancerous lesions.2
  • Women living with HIV have increased rates of co-infection with high risk HPV and cervical intraepithelial neoplasia (CIN) when compared to their HIV-negative counterparts.6,7
  • Pap testing has significantly reduced mortality from cervical cancer.2,3
  • Breast cancer is the most prevalent form of cancer in women in the general population, and the second leading cause of cancer death in US women.1, 3, 4
  • HIV-positive women have breast cancer rates similar to those of the general population.3
  • Evidence shows that screening mammography significantly reduces breast cancer mortality, especially in women ages 50-74, because of its ability to detect breast cancers before they become palpable or symptomatic.4,6


Links for Health Maintenance

  1. WHO's Comprehensive Cervical Cancer Control: A Guide to Essential Practice.
  2. BHIVA's UK Guidelines for the management of sexual and reproductive health of people living with HIV infection (2008).
  3. WHO's Breast Cancer: Prevention and Control.
  4. ACOG's Gynecologic Care for Women with Human Immunodeficiency Virus.
  5. ACP's Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.
  6. IDSA Guidelines: Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: 2009 Update by the HIV Medicine Association of the Infectious Diseases Society of America.

 

References

  1. Sigel K, Dubrow R, Silverberg M, Crothers K, Braithwaite S, Justice A. Cancer screening in patients infected with HIV. Curr HIV/AIDS Rep. 2011;8(3):142-152
  2. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. CA Cancer J Clin. 2012;62(3):147-172.
  3. Centers for Disease Control and Prevention (CDC). Invasive cancer incidence—United States, 2009. MMWR Morb Mortal Wkly Rep. 2013; 62(07); 113-118
  4. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716-726, W-236.
  5. Smith RA, Saslow D, Sawyer KA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53(3):141-169.
  6. AIDS Education and Training Centers.  Cervical dysplasia. Accessed 1 Sept 2013.