女性愛滋病毒感染者子宮頸癌防治與建議

Exploring the Issue of Cervical Cancer Prevention and Control in Women Living With HIV/AIDS

女性容易因同樣的性行為機會感染愛滋病毒（human immunodeficiency virus, HIV）與人類乳突病毒（human papillomavirus, HPV），且女性HIV感染者的免疫系統會受到HIV破壞，容易增加子宮頸細胞癌變的機會，因此女性HIV感染者的子宮頸癌防治尤其亟需重視。綜合數篇研究結果發現，女性HIV感染者較一般女性容易：1.感染HPV，且是高危險型的HPV，及同時感染多型的HPV，感染HPV後自動清除的時間較長，產生子宮頸癌症病變，癌前病變進展為癌症較快，且治療後易再復發；2.影響子宮頸癌病程的因素與免疫細胞CD4（cluster of differentiation 4）低及HIV病毒量高有關，與服用抗愛滋病毒藥物沒有直接的相關。本文提出建議如下：1.醫療體系及社政體系應提供女性HIV感染者安全性行為的教育與性諮商的服務；2.免費補助女性HIV感染者每年兩次子宮頸抹片檢查；3.監測女性HIV感染者抹片篩檢比率及結果；4.鼓勵女性性病個案及子宮頸癌變個案在篩檢前諮商下檢測HIV或HPV，以及定期追蹤抹片結果；5.加強男性HPV防治工作。 Shared risk factors mean that women engaging in unprotected sex are at risk of contracting both the human immunodeficiency virus (HIV) and the human papillomavirus (HPV). As HIV suppresses bodily immune systems, an HIV-positive woman with HPV will likely see a faster progression of cancer cells around the cervix. Therefore, it is important to prevent and control cervical cancer in HIV-positive women. Findings from the literature on this topic include: 1) HIV-positive women face a relatively greater risk of: HPV surveillance, contracting high-risk HPV subtypes, contracting more subtypes of HPV, longer HPV clearance time, and acquisition, persistence, progression and relapse of cervical dysplasia and cancer and 2) Factors related to cervical cancer progression in HIV-positive women correlated with lower CD4 counts and higher viral loads, but not with anti-HIV medication. Based on such, we suggest: 1) Medical and social service systems should target appropriate safe sex education and sex counseling to HIV-positive women; 2) HIV-positive women should receive a free Pap smear twice yearly; 3) Health authorities should monitor Pap smear screening rates and HIV-positive results; 4) Encourage women with STDs and cervical dysplasia to undergo HIV and HPV testing during pretest counseling and regularly follow Pap smear results; and 5) Enhance HPV prevention in men.

Shared risk factors mean that women engaging in unprotected sex are at risk of contracting both the human immunodeficiency virus (HIV) and the human papillomavirus (HPV). As HIV suppresses bodily immune systems, an HIV-positive woman with HPV will likely see a faster progression of cancer cells around the cervix. Therefore, it is important to prevent and control cervical cancer in HIV-positive women. Findings from the literature on this topic include: 1) HIV-positive women face a relatively greater risk of: HPV surveillance, contracting high-risk HPV subtypes, contracting more subtypes of HPV, longer HPV clearance time, and acquisition, persistence, progression and relapse of cervical dysplasia and cancer and 2) Factors related to cervical cancer progression in HIV-positive women correlated with lower CD4 counts and higher viral loads, but not with anti-HIV medication. Based on such, we suggest: 1) Medical and social service systems should target appropriate safe sex education and sex counseling to HIV-positive women; 2) HIV-positive women should receive a free Pap smear twice yearly; 3) Health authorities should monitor Pap smear screening rates and HIV-positive results; 4) Encourage women with STDs and cervical dysplasia to undergo HIV and HPV testing during pretest counseling and regularly follow Pap smear results; and 5) Enhance HPV prevention in men.