How long do people living with HIV have cancer? Risk factors and prevention of cancer in HIV-infected people

Cervical cancer in HIV-infected women

Popova M.Yu., Tantsurova K.S., Yakovleva Yu.A.

Federal State Budgetary Educational Institution of Higher Education South Ural State Medical University of the Ministry of Health of Russia

Department of Obstetrics and Gynecology

Cervical cancer in HIV-infected women

Popova M.Yu., Tantsurova K.S., Yakovleva Yu.A.

Federal State Budgetary Educational Institution of Higher Education South Ural State Medical University of the Ministry of Health of Russia

Department of Obstetrics and Gynecology

Relevance. Cervical cancer (CC) is one of the most common malignant tumors of the female reproductive system. Among cancers in young women, cervical cancer has the highest mortality rates. Cervical cancer originates from the normal cells that line the cervix. Every year this tumor is detected in more than 600 thousand patients. Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS) and is a risk factor for the development of squamous intraepithelial lesion (SIL), which occurs as a result of impaired immune control. Over time, SIL progresses to invasive cervical cancer.

Goal of the work. To study the features of the occurrence, course, diagnosis, and treatment of cervical cancer in HIV-infected women.

Research objectives. To establish the relationship between the progression of cervical cancer in women with HIV-positive status.

Materials and methods. According to the classification, LSIL, or Low grade SIL, or mild degree, and HSIL, or Hight grade SIL, or severe degree, are distinguished. SIL should be treated promptly (by removing or destroying the outer layers of cervical cells

uterus) to prevent it from developing into invasive cancer.

In HIV-infected women, the transition from SIL to cervical cancer occurs much faster than in healthy women, due to damage to the immune system. HIV affects human blood cells that have CD4 receptors on their surface, namely: T lymphocytes, macrophages and dendritic cells. Infected T lymphocytes die due to destruction by the virus, apoptosis, and killing by cytotoxic T lymphocytes. If the number of CD4+ T lymphocytes falls below 200 per microliter of blood, the cellular immune system ceases to protect the body. Studies have shown that untreated cervical neoplasia is more likely to develop into invasive cancer in HIV-infected women than in healthy women.

Neoplasia is diagnosed using methods such as cervical biopsy, which is a medical procedure that allows one to specifically take pathologically altered tissue of the cervix for the purpose of morphological examination. The diagnosis uses a Papanicolaou smear - this is scraping the tissue of the surface layer of the cervix and examining the resulting cells under a microscope after treatment with dyes. The liquid cytology method is a more modern and informative version of screening using the Papanicolaou test (PAP test), the “gold standard” for diagnosing neoplasia of the cervical mucosa, used when patients are suspected of having cancer or dysplasia. Due to the fact that absolutely all cellular matter enters the stabilizing solution, the quality of the material improves.

In liquid cytology, material is collected using cytobrushes, which are designed to take biological material from the surface of the cervix and from the cervical canal for cytological and bacteriological studies, while the sample is not immediately transferred to glass, but the cytobrush with the collected material is immersed in a special solution and then using The device prepares a sample for research. The cytobrush is easy to use and atraumatic for taking material. If necessary, the working part can be bent at any angle relative to the handle. This allows you to adapt the instrument depending on the anatomical features of the area from which the material is taken.

Studies have shown that untreated cervical neoplasia is more likely to develop into invasive cancer in HIV-infected women than in healthy women. To treat dysplasia in an HIV-positive patient at the LSIL stage, a laser is used (non-contact, bloodless, safe). This dysplasia responds well to treatment, since the laser destroys the damaged tissue, sealing the blood vessels and stopping the bleeding (simultaneously with the removal of the damaged tissue, their coagulation occurs, small blood vessels “close” at the vaporization site, which makes the intervention practically bloodless). The entire procedure takes place under the supervision of a colposcope, which magnifies the desired area up to fifteen times; a finely focused laser beam can be directed precisely, under the control of a video colposcope, to the desired location, which allows you to remove only changed tissue. At the HSIL stage there should only be excision of pathologically changed tissue. The chances of relapse in HIV-infected women after treatment are quite high. Women with a CD4 cell count of less than 50 per microliter of blood are at higher risk of relapse. Recurrence of SIL in HIV-positive women is not associated with its stage, but is determined by the total number of T lymphocytes and CD4. Women who have been diagnosed with HIV must undergo cytological screening at least once every 6 months after treatment of identified genital infections, as well as testing for human papillomavirus (HPV), due to the risk of developing SIL, CC, and determining the CD4+ count. The only currently known method of increasing T-cell immunity and reducing the viral load in HIV-infected people is highly active antiretroviral therapy (HAART), which is used in the complex treatment of HIV-infected people. The method of therapy consists of taking three or four drugs, as opposed to the monotherapy (1 drug) that was used previously. The use of monotherapy is not advisable due to the high likelihood of developing viral resistance during the first 3 months of treatment. HAART includes three nucleoside reverse transcriptase inhibitors (NRTIs), two NRTIs + one or two protease inhibitors (PIs), two NRTIs + one non-nucleoside reverse transcriptase inhibitor (NNRTI), and NRTIs + NNRTIs + PIs.

Therapy requires strict adherence to the dosage schedule. It is unacceptable to skip doses of medications, as well as to take reduced or increased doses in case of skipping.

The appearance and development of cervical cancer is a multi-stage process. The stages of development of cervical cancer are presented as follows: normal cervical epithelium => epithelial dysplasia (mild, moderate, severe) => intraepithelial cancer (or stage 0 cancer, non-invasive cancer) => microinvasive cancer => invasive cancer. The earliest manifestations may be watery, copious discharge, bloody discharge, which in women of childbearing age is not associated with menstruation, and in postmenopausal women is observed constantly or periodically; the discharge may have an unpleasant odor. The discharge of urine and feces through the vagina is evidence of urinary and rectal-vaginal fistulas. At stage IV, metastatic inguinal and supraclavicular lymph nodes appear.

Cervical cancer is divided into four stages (I, II, III and IV), each stage is divided into two substages (A and B), and each of substages IA and IB into two more - IA1, IA2 and IB1, IB2. The choice of treatment for cervical cancer depends on the stage of the disease. Surgical treatment is used for stages IA1, IA2, IB and less commonly IIA. The extent of the operation depends on the depth of invasion, the presence of metastases in the pelvic and para-aortic lymph nodes. At stage IA1, it is possible to perform conization of the cervix (wedge biopsy, cone excision - amputation of a cone-shaped section of the cervix, which consists of removing part of the cervix in the form of a cone) or simple extirpation of the uterus with appendages: tubes and ovaries. At stages IA2, IB1, IB2 and IIA, radical hysterectomy with removal of the pelvic and sometimes para-aortic lymph nodes is indicated. During this operation, in addition to the uterus with appendages and lymph nodes, the upper third of the vagina, as well as parts of the uterine ligaments and fatty tissue of the parametrium and tissue surrounding the cervix are also removed. If metastases are detected in the lymph nodes, treatment after surgery is supplemented with radiation or simultaneous chemoradiotherapy. Usually combined treatment (surgery + radiation therapy) is carried out for stages IB and IIA. Sometimes, for invasive cervical cancer (stages IA2, IB1), a complex radical operation is performed, which allows preserving reproductive function, called trachelectomy. During surgery, only the cancerous cervical tissue and surrounding lymph nodes are removed. The effectiveness of surgical treatment and radiation therapy in the early stages of invasive cervical cancer is almost the same; radiation therapy is used in the form of external gammatherapy and brachytherapy. The duration of combined radiation therapy (external beam and brachytherapy) should not exceed 55 days. For stages IB2-IV, simultaneous chemoradiotherapy is recognized as the standard treatment worldwide (previously, only radiation therapy was performed for these stages). In stage IVB, only chemotherapy can be used. However, women with AIDS and cervical cancer at the same time are not cured of cancer as successfully as HIV-negative patients.

Research results. Thus, due to the high likelihood of cervical cancer in HIV-infected women and in order to detect it early, they need to have a PAP smear; if atypical cells are not detected, the test must be repeated six months later, and then, if the results are negative, 1 time per year. If all types of SIL are detected in the Pap smear, colposcopy is performed with targeted biopsy of altered areas of the uterine mucosa. This allows not only to detect cervical cancer in the initial stages, but also to prevent its development by diagnosing precancerous changes in the cervical epithelium, the treatment of which prevents the development of a tumor.

Conclusions. AIDS-associated cervical cancer develops more rapidly than cervical cancer in HIV-negative women and leads to numerous complications. Women who are HIV positive are more likely to develop precancerous cervical cancer into invasive cancer than HIV-negative women. Women with AIDS and HIV-infected women should be constantly monitored by the health care system, as they have a higher risk of developing cervical cancer.

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HIV infection affects the human immune system, causing various diseases that the body is not able to resist properly. Because of this, the appearance of any cancer may mean the approach or onset of the extreme stage of the development of HIV - acquired human immunodeficiency syndrome. Such diseases are called AIDS-associated. These include: Kaposi's sarcoma, invasive cancer of the cervix, anal canal, oral cavity, various lymphomas, Hodgkin's disease and malignant melanoma.

Kaposi's sarcoma is a type of cancer closely related to AIDS. It was discovered by the Hungarian dermatologist Moritz Kaposi and named after him. Typically appears as pink or red spots on the skin or in the mouth. May also attack the eyes and appear in internal organs. The prevalence of this disease is low, but Kaposi's sarcoma ranks first among malignant neoplasms affecting patients with HIV infection, reaching figures of 40-60%. Previously, this type of cancer was found primarily in older people of Mediterranean or Jewish origin, as well as organ transplant patients and young people from Africa. In 1983, Kaposi's sarcoma was diagnosed in Rock Hudson, a popular actor in American family films in the 50s and 60s of the last century. The examination confirmed that he had AIDS. He died in his sleep in 1985. Unfortunately, only after the death of such a famous actor did the media begin to openly discuss the topic of HIV.

In a number of progressive countries, 4 out of 10 AIDS patients were previously diagnosed with the development of cancer. Now, with the development of antiretroviral drugs, these indicators are significantly better. This was also achieved through the promotion of a healthy lifestyle, since smoking increases the chance of developing cancer.

Very often, patients with oncology cannot complete the full course of chemotherapy without causing enormous damage to their body. Thus, the problem with treating cancer in HIV-positive people is that their body is already weakened, and because of this, even more serious side effects may occur. The introduction of highly active antiretroviral therapy reduces some types of cancer in those infected and helps increase life expectancy, allowing such people to complete a full course of chemotherapy.

For HIV-positive women, cervical cancer is a particular danger, which must be detected and treated early. But here it is important to significantly reduce the viral load for surgical intervention, since traditional treatment methods for infected women are practically of no help.

Is there any way to minimize the risk of cancer in HIV-positive people? To begin with, you must always and constantly take antiretroviral therapy prescribed by your doctor. In addition, experts advise adhering to a healthy lifestyle, as this will help you better control HIV and at the same time reduce the risk of cancer. It is also necessary to give up all bad habits, especially smoking - this is the most important step in protecting against tumors.

Although the direct connection between the human immunodeficiency virus and cancer has not been fully established, tumors develop faster against the background of weakened immunity. It is also worth remembering that cancer treatment for HIV is much more difficult. Chemotherapy for people with AIDS is very difficult because the bone marrow, which produces new blood cells, is affected by the virus.

Doctors at the Cancer Center at Children's Hospital in Philadelphia (USA) have made a real breakthrough in medicine by learning to treat cancer with HIV. Experts conducted research in the field of genetic engineering and were able to reprogram the deadly virus. Thus, in three weeks, HIV cured a girl who had two days to live, reports CBS.

Seven-year-old Emily Whitehead from New Jersey battled lymphoblastic leukemia for two years. Doctors prescribed her radiation and chemotherapy sessions, but there were no visible results. In the end, the girl felt a little better, but right before the difficult operation for a bone marrow transplant, she had a relapse. Then the doctors put an end to the possibility of recovery. Emily had only days left before her organs would fail.

Then the parents moved the girl to the children's hospital in Philadelphia, which is famous for one of the best cancer centers in the United States. The center's director, Stefan Grup, offered the parents an experimental but promising treatment called CTL019 therapy.

The essence of the method is that scientists modify the HIV virus. Its genetic code is altered so that the infected T cell attacks cancerous tissue while sparing healthy tissue. Healthy lymphocytes do not participate in the fight at all. Infected T cells recognize cancer cells thanks to a specific protein called CD19. The treatment is incredibly dangerous: infection is accompanied by the final decline of an already weakened immune system, as well as terrible pain. Emily had little chance of surviving the first night after the operation, but without intervention the girl would not have survived two days.

After the introduction of the modified virus, Emily's condition improved in just a few hours. Doctors noted that she began to breathe more smoothly, and her temperature and blood pressure returned to normal. To the surprise of the doctors, after three weeks there was no trace of cancer left. Six months have passed since the completion of the course, which was carried out in April, but there are still no traces of cancer in the baby’s body. Infected T cells protect the body and now this is another advantage of the new treatment method over traditional methods.

An additional 12 patients were treated with CTL019 therapy. Nine of these attempts ended positively. Two other children who took part in the studies also experienced complete remission.

Despite the fact that the cost of treatment is quite high (20 thousand dollars per session), scientists hope that this method will develop, become more accessible and help millions of people who have lost hope. It is likely that over time this procedure will eliminate the need for an expensive bone marrow transplant.

Emily's parents are extremely proud of their brave daughter, who seemed to be less afraid than others and fought her illness to the last. Now the girl leads a normal life - goes to school, plays, which her family is very happy about.

Doctors at the Cancer Center at Children's Hospital in Philadelphia (USA) have made a real breakthrough in medicine by learning to treat cancer with HIV.

Experts conducted research in the field of genetic engineering and were able to reprogram the deadly virus. Thus, in three weeks, HIV cured a girl who had two days to live, reports CBS.

The essence of the method is that scientists modify the HIV virus. Its genetic code is altered so that the infected T cell attacks cancerous tissue while sparing healthy tissue.

Healthy lymphocytes do not participate in the fight at all. Infected T cells recognize cancer cells thanks to a specific protein called CD19. The treatment is incredibly dangerous: infection is accompanied by the final decline of an already weakened immune system, as well as terrible pain. Emily had little chance of surviving the first night after the operation, but without intervention the girl would not have survived two days.

An additional 12 patients were treated with CTL019 therapy. Nine of these attempts ended positively. Two other children who took part in the studies also experienced complete remission.

The human immunodeficiency virus inhibits the body's defense system. This is why HIV-infected people are at increased risk of developing serious diseases, including cancer. We figured out what HIV-associated cancers are, what risk factors influence the development of cancer in HIV-positive people, and how they can be reduced.

Is it true that people living with HIV have an increased risk of developing cancer?

The likely reduction in cancer incidence is due to the fact that antiretroviral therapy reduces the amount of immunodeficiency virus circulating in the blood. This, in turn, allows us to partially restore the protective function of the immune system: the body fights oncogenic viruses, which cause up to 15% of all malignant tumors.

Although the risk of HIV-associated cancer has been decreasing in recent years, it still exceeds the level typical for the rest of the population. This can be attributed to two facts. Firstly, not all HIV-positive people know about their status. And secondly, although taking HAART restores the immune system, it cannot return it to a completely healthy state. Often, people living with HIV have difficulty accessing health care or do not receive adequate antiretroviral therapy for other reasons. Also, with the introduction of HAART, the incidence of cancer not associated with AIDS increased. Thanks to antiretroviral therapy, HIV-positive people are living longer, and this is one of the main risk factors.

How can you reduce the risk of developing cancer?

First, take antiretroviral therapy. This will definitely reduce the risk of Kaposi's sarcoma and non-Hodgkin's lymphoma and increase the patient's life expectancy.

Secondly, the risks of developing lung, throat and other cancers can be reduced by quitting smoking. Researchers estimate that tobacco prevention programs among adolescents at risk of HIV infection could prevent up to 46% of cancer cases in HIV-infected adults.

Hepatitis C virus increases the risk of liver cancer. If the diagnosis is positive, it is necessary to regularly check the liver and reduce the consumption of alcoholic beverages.

Human papillomavirus and related diseases can be prevented by vaccination. HPV vaccination is recommended for all girls and young women aged 11 to 26 years before becoming sexually active. Regardless of whether a woman has been vaccinated, she must undergo a cytological test (Pap test) or HPV test every 3-5 years, starting at age 21.

Anal cancer is also caused by HPV. It is important to remember that people who have anal sex without barrier protection are at particular risk. Screening using a Pap test can detect early stages of cancer, and timely treatment often prevents tumor progression.