HIV-positive women at greater risk from cervical cancer

Johannesburg, 03 June 2009—A growing threat faces women suffering from HIV – the increased risk of developing cervical cancer.
South Africa’s leading HIV treatment centre at Themba Lethu Clinic in Johannesburg has found that 72% of its female patients, with an average age of 35, have never had a pap smear. This is despite the medical profession’s recommendation that all women, and not simply those who are HIV-positive, should undertake such tests at ages 30, 40, and 50.
Dr Cindy Firnhaber, senior investigator at the Themba Lethu says, “Invasive cervical cancer is an AIDS-defining illness, but not enough emphasis is put on it in the developing world.”
Of 2000 women at the clinic who are participating in a study of the problem, more than half have abnormal pap smears or have presented changes that could indicate the presence of a pre-cancerous condition called cervical dysplasia that may develop into cervical cancer. It is not a given, according to Firnhaber, that all these patients will contract cervical cancer, but some will.
The human papilloma virus (HPV) is transmitted sexually and can evade the immune system, causing cervical dysplasia and cervical cancer.
Earlier this month, Firnhaber attended the 25th annual HPV International Conference at Malmo in Sweden. Among the conference’s key findings were that the prevalence of HPV increases the transmission of HIV, and vice-versa; that the treatment of HPV is less successful in HIV-positive patients as in HIV-negative women; and that different kinds of treatment to prevent HPV dysplasia are under ongoing investigation because the diverse types of oncogenic HPV are not all targeted by available preventative vaccines.
The threat posed to women with the HPV virus – which can cause a variety of cancers – is that there are often no symptoms. As Firnhaber points out, it is a “silent” disease that can only be successfully treated if it is caught early and repeatedly monitored through Pap smear tests. Pap smear results have been shown to drastically reduce the onset of cervical cancer in the developed world and in South Africa, with its high rate of HIV infection, there is a greater risk of this cancer because of limited access to care.
Firnhaber emphasises, “It is really important to include cervical cancer screening within HIV clinics but the problem is that this screening is often only available in another clinic, in another building, and this leads to logistical difficulties for patients. Women with HIV often feel stigmatised and are therefore reluctant to visit more than one clinic. As a result, they do not present themselves for regular Pap smears.”
Themba Lethu Clinic – the flagship site of the fast-growing NGO Right to Care – boasts a one-stop cervical cancer screening and treatment centre alongside its HIV treatment facility. The clinic has taken the lead in offering highly skilled and verified corposcopy for HIV positive patients presenting cervical disease from HPV. Since last October, its doctors have successfully performed over 100 loop electro surgical excision (LEEP) procedures that remove those areas in the cervix that are affected or changed by HPV.
Other one-stop HPV and HIV sites under the Right to Care umbrella are operating successfully at Natalspruit Hospital on the East Rand, Leratong Hospital in the West Rand, ACTS clinic in White River, and the Topsy Foundation in Dipaleseng, Mpumalanga.
Several other Right to Care HIV treatment centres in Gauteng, Mpumalanga, Limpopo, and the Northern Cape will soon offer similar HPV screening and treatment programmes.
Right to Care has an ongoing training programme that is enabling a growing number of medical officers to perform Pap smear tests and to assist in HPV dysplasia surgical procedures.
“Cervical cancer is both treatable and preventable,” says Firnhaber, “but catching it early is the key.”

For further information, contact Dr Cindy Firnhaber at Right to Care, 011-276-8850, email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .