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Human papillomavirus-related tumors in HIV

Palefsky, Joel

doi: 10.1097/01.cco.0000239885.13537.36
Cancer in AIDS

Purpose of review Human papillomavirus-related anogenital cancers are theoretically preventable. Many HIV-infected women do not undergo routine cervical cytology screening, however, and there are currently no routine anal cytology screening programs. This review focuses on recent developments that may impact on the future incidence of these cancers: the effect of highly active antiretroviral therapy and the imminent approval of vaccines to prevent initial human papillomavirus infection.

Recent findings Highly active antiretroviral therapy has limited benefit to reduce the incidence of cervical intraepithelial neoplasia 3 and no benefit to reduce the incidence of anal intraepithelial neoplasia 3. Consistent with these findings, there has been no reduction in the incidence of cervical and anal cancer since the introduction of highly active antiretroviral therapy. More encouraging is the development of highly effective preventive human papillomavirus vaccines that are projected to reduce the incidence of cervical cancer by up to 70% among vaccinated women.

Summary HIV-positive men and women remain at risk for human papillomavirus-associated cancers, even in the highly active antiretroviral therapy era. Conversely, the incidence of anogenital cancers may decline in the future among HIV-positive individuals if they received the human papillomavirus vaccine before they acquired HIV infection, and studies should be done to assess the safety and efficacy of the vaccines in individuals already infected with HIV.

Department of Medicine, University of California, San Francisco, California, USA

Correspondence to Joel Palefsky, MD, Department of Medicine, Box 0126, 505 Parnassus Avenue, Room M1203, University of California, San Francisco, CA 94143, USA Tel: +1 415 476 1574; fax: +1 415 475 0986; e-mail:

Conflict of interest: J.F. receives grant support from Merck and Co.

© 2006 Lippincott Williams & Wilkins, Inc.