This study is being led by Dr Cindy Firnhaber, an HIV physician with over 15 years experience in HIV and AIDS care both in America and South Africa. Firnhaber is now working with the government to develop a cervical cancer screening programme for HIV-positive women. Her study, which started four years ago, involves 2000 women attending the Right to Care Thembalethu AIDS Clinic at Helen Joseph Hospital, in Johannesburg. Interim results suggest that a significant number of them could develop cervical cancer or cancer of the cervix.
‘Over 1000 of them have early changes that could lead to cervical cancer. It doesn’t mean they have cervical cancer, but they have early changes. That’s quite a few ‘ that’s 1 in 2. We want to treat those women early to get those changes out before they progress to cancer. And about 300 ‘ 400 of those women have changes that are pretty significant – that if we don’t take them out now they could in a year’s time, maybe, develop into a cancer, or longer, it’s hard to know. But it’s very important that we get those abnormal cells out now’, she explains about the finding.
‘We are seeing much higher rates of pre-cancerous lesions or early cancers. We’re seeing higher rates of actual cervical cancer also. And then, we’re beginning to see that these women – which is something we’ve known – don’t clear the virus as well, their bodies are not able to repair these abnormal cells as well as a woman without HIV’.
‘We are seeing rates between 200 ‘ 300 women per 100 000 women, which is quite high. It’s much higher than’¦ like in the United States, per se, where we are seeing about 7 ‘ 10 per 100 00. So, we are seeing a significant increase in cervical cancer, here. Part of that is due to more the HIV epidemic and part of that is due to the access to screening’¦ it’s not as available. General figures for the women in South Africa has been about 30 ‘ 40 per 100 000’, Firnhaber adds.
But why are HIV-positive women more likely to develop cervical cancer?
‘Cervical cancer is caused by a sexually transmitted virus called Human Papilloma Virus (HPV). We do know that the lower the CD 4 count or the weaker the immune system, the more likelihood that women who have been exposed to HPV virus are going to maintain that virus in the cervical area”.
“They’re not able to clear the virus as well, like when you get a cold and you have a normal immune system, you’re able to clear the virus. But with your immune system being weakened, you don’t have the strength in your immune system to clear the virus. And once this virus incorporates itself into the DNA or the cervical cells, it’s more likely to change the cells to become pre-cancerous lesions and go on to cancerous lesions’, she explains.
The study was approved by Wits University’s ethics committee and is due for completion next April.