HIV infection and Invasive cervical carcinoma in an Italian population: The need for closer screening programmes in seropositive patients

Objective: To evaluate in an Italian population the prevalence, characteristics at first diagnosis and outcome of HIV-seropositive individuals with cervical carcinoma referred to a tertiary-care institution.Design: A retrospective evaluation of all patients referred for invasive cervical carcinoma from 1991 to 1994.Setting: The departments of obstetrics and gynaecology, and radiotherapy at San Gerardo Hospital, University of Milan, Italy.Patients: A total of 340 women were treated over a 3-year period (186 aged <50 years). Six patients were found to be HIV-seropositive.Interventions: Seropositive patients were treated according to current institutional protocols, irrespective of HIV status. Four underwent radiotherapy and two radical hysterectomy as primary treatment.Results: Although five HIV-seropositive patients were known to be infected 13-81 months before diagnosis of cervical cancer, none had received a PAP smear in the last year and only one in the last 2 years. HIV patients were younger than general population (P=0.02), with a significant history of intravenous drug use (P=0.000001) and with more advanced disease (P=0.04). Two HIV-positive patients also received polychemotherapy (one adjuvant and one salvage treatment) and both completed the planned treatment. Within 24 months two patients had died of cancer and one of AIDS; one is alive with AIDS and cancer and two are free of disease.Conclusions: This study confirms that in a southern European population, HIV-seropositive women present to tertiary-care institutions with more advanced disease and have a poorer prognosis than the general population. Strict screening programs for cervical dysplasia and cancer are warranted for HIV-seropositive patients.