Invasive and preinvasive cervical neoplasia in human immunodeficiency virus-infected women.

An association between human immunodeficiency virus (HIV) infection and cervical neoplasia in women has recently been recognized. Cervical cancer was designated as a diagnostic criteria for acquired immunodeficiency syndrome (AIDS) in HIV-infected women in 1993. The two conditions share a number of risk factors, including a history of multiple sexual partners and disproportionate effect on younger women and ethnic minorities. HIV appears to accelerate the pathogenesis of cervical neoplasia at the molecular level, although clinical evidence of disease progression is limited. The optimal strategy for screening HIV-infected women for cervical neoplasia is unclear, but should include at least an annual Papanicolaou (Pap) smear. Preinvasive cervical neoplasia in HIV-infected women should be treated with standard excisional/ ablative therapy, followed by vaginal 5-flourouracil cream. Invasive cervical cancer should be treated with standard surgical therapy or radiotherapy. Recurrence rates are high following treatment of either invasive or preinvasive disease, but are reduced in women undergoing highly active antiretroviral therapy.