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HPV Infection in Immunocompromised Patients
Patients develop compromised immune systems for reasons including HIV infection, treatment with chemotherapy for cancer, and the use of immunosuppressants following an organ transplant. HPV infection can cause a variety of clinical manifestations including genital warts, cervical dysplasia, cervical epithelial neoplasia (CIN), and invasive cervical carcinoma. HIV-infected women have a higher risk of HPV infection that can lead to cervical abnormalities. HPV infection is more persistent in HIV-infected women, and the viral types most commonly associated with malignant transformation (HPV 16 and 18) are more common in HIV-infected women, especially as the immunosupression progresses.
Cervical dysplasia or CIN are reported in HIV-infected women at rates of 15 percent to 40 percent. Furthermore, there is a significant risk of short-term recurrence (40 to 60 percent) following standard therapies for pre-invasive diseases, such as cyotherapy, loop excision, laser therapy and cone biopsy. Evidence suggests that HIV-infected women with atypical squamous cells (ASCUS) of undetermined significance on Pap smears will have a higher rate of progression to CIN. Invasive cervical cancer in the HIV-infected women is characterized by high grade tumors, lymph nodes and other mestastatic involvement at the time of diagnosis. The response to therapy is uniformly poor, and most women will die of their cancer as opposed to the HIV infection. Invasive cervical carcinoma is now an AIDS-defining illness.
Serious HPV-related diseases
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