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by Enid Vázquez
Despite many frustrations, Lea’s been
successfully able to both prevent cervical cancer from developing,
and to treat it when it did.
That takes regular check-ups
and follow-up on abnormalities. Lea’s great about getting
good health care.
Her Pap smear abnormalities
began when she was a teenager, long before she had HIV, and
she had them taken care of every time. Abnormalities are not
so strange, since human papilloma virus (HPV), which can lead
to cancer of the cervix, is a very common infection in women.
But if left untreated, abnormal
cervical cells—no matter what causes them—may become cancerous.
A Pap smear looks for abnormalities in the cervix, the lower
part of the uterus that leads into the vagina. Every woman
over the age of 18 should have one done every year. Thanks
to Pap smears, cervical cancer has decreased by 70% over the
past several decades.
For women with HIV, all the
problems seen with the cervix are more complicated than in
HIV negative women. Positive women are much more likely to
have abnormal cell growth and other conditions, including
serious abnormalities. They’re also much more likely to be
infected with HPV.
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As a result of
her exams, Lea’s had eight surgeries, four of those before
she was positive. Most of these treatments can be performed
on an outpatient basis (no hospitalization). Thanks to her
regular exams and follow-up, she remains cancer-free. And
because HIV medicines are shown to reverse certain conditions
that can lead to cancer, her drug combination may be helping
to keep cancer away.
For now, the only
treatment gynecologists have for preventing cervical cancer
is to freeze, burn off, or just plain cut out abnormal cells.
Lea started out with
cryotherapy (or freezing, a process that’s no longer recommended
for positive women) at age 18. Later she had laser surgery
(destroying abnormal tissue by zapping it with a laser). Then
she had a cone biopsy, a surgical procedure in which part
of the cervix is cut off (in the shape of a cone). Then a
year later she had a LEEP, another cutting off process (see
“Treatments”). A year later, again abnormal tissue. This time
she had a hysterectomy (removal of the uterus). Ironically
for Lea, who has a T-cell count of 860 and undetectable viral
load, the incidence of serious problems has been shown to
increase when a woman has less than 200 T-cells, as you would
expect. Obviously there’s still a risk with good numbers,
as with all negative women.
But now abnormal cells
are back. At this point, her treatment is that old standby,
“close monitoring.” Her doctor has upped Lea’s Pap smears
from once every six months to every three months. Her option
now is 5-FU, which she was told is “a messy, burning cream”
that takes off the abnormal cells. But it’s painful, and she
would need a prescription for a painkiller. Or she would need
more surgery.
Lea advises women
to continue monitoring for problems. “Be prayerful,” is her
first advice. Then, “If there are any suspicions whatsoever,
go to the doctor. And don’t be afraid to ask questions. And
last, don’t be afraid to have the doctor examine you. Women
get so sick of these gyne exams. But there’s that good catch
phrase doctors use, ‘At least we caught it in time and we
can do something about it.’ That’s always good to hear.”
Dr. Mardge H. Cohen,
director of the Women’s Intragency HIV Study in Chicago, agrees.
“The point is that careful monitoring is important. Low-grade
lesions need attention. Most people with high T-cells and
undetectable viral load do like everybody else who are uninfected
and do better. HPV is common, more so in HIV infected women.
They need to be encouraged to connect with their health care
provider so that we can give appropriate treatment. There
are no progressions to cancer, if appropriate therapy is instituted.”
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