Cervical disease and cancer in HIV positive women. Recommendations for screening and diagnosis.

Cancer and cervical disease occur more frequently in HIV infected women than in HIV negative. HIV infection is associated with an increased prevalence and severity of Human Papilloma Virus (HPV) associated cervical intraepithelial lesions. Advanced HIV disease is the strongest independent risk factor for cancer associated HPV infection. Up to now, there have been limited and controversial data on the effect of High Active Antiretroviral Therapy (HAART) on the natural history of cervical lesions. The major risk factors associated with cervical cancer detection are similar in HIV positive and negative women and include lack of screening and prolonged duration of symptoms. HIV positive women should have a complete gynaecological examination, including a Pap test, which should be performed twice in the first year after the diagnosis of HIV infection. Referral for colposcopy and biopsy should be recommended in case of abnormal cytology.