Cervical cancer is affecting HIV-positive women at a younger age than the average population. Usually cervical cancer develops between the ages of 45 and 54, but with a co-infection of HIV, it is developing as early as 35 years of age.
"About 10 years of life is lost," says Johannesburg gynaecologist Dr Peter Koll, referring to the earlier onset of cervical cancer among HIV-positive women.
But the earlier onset of the disease is not the only challenge facing HIV-positive women with regards to cervical cancer. "HPV-infection rates among HIV-positive women are ten times greater than those among HIV-negative women," says the Treatment Action Campaign's (TAC) national women's rights campaign manager, Nomfundo Eland. "This is partly due to the compromised immunity of HIV-positive women."
Link with HPV
Unlike most other cancers, cervical cancer is caused by strains of the human papillomavirus (HPV).
Strains 16 and 18 – that are responsible for 70% of cervical cancers - are usually transmitted through sexual contact with an infected person. Men carry the virus, and can spread it, but are not affected by it. HPV is a very common and some experts estimate that up to 80% of sexually active adults are infected.
What's unique about cervical cancer is that there is a vaccine that can prevent up to 70% of cases. It is a very new product and was only approved by the Medicines Control Council (MCC) for use in South Africa in February of this year and currently it is only available in the private sector.
Safety in HIV-positive patients
"Because HPV-associated disease is so prevalent in HIV-positive women, it would be particularly useful to vaccinate women who might become HIV positive in the future, so that they are protected," Professor Lynette Denny of the University of Cape Town told Mail & Guardian Online.
However, at the moment there is no data on whether it is safe and effective for use in people infected with HIV. "We don't claim that it is effective in HIV-positive people," says Mr David Pritchard, general manager of the pharmaceutical company GlaxoSmithKline (GSK) who manufactures on of the two vaccines available in South Africa.
"There is no theoretical reason for it to be unsafe (in HIV-positive women)," argues Koll and says that one should balance the risk of cervical cancer against an improbable negative effect from the vaccine.
Denny is currently undertaking a study to test the safety and immunogenicity of the bivalent vaccine in HIV-positive women.
As mentioned before, the vaccine is currently only available in the private sector and retails at R1 350 for Cervarix (the GSK product), and R2 310 for Gardasil (the MSD product) for the three shots required.
But even the reduced GSK price puts this product out of reach of the women who need it most. "Roughly 80% of these cases (cervical cancer) are in the developing world," says Eland. "Generally due to poor screening programmes and diagnostics in these communities."
Countries such as the USA, UK and Australia have implemented the vaccine into their public health systems and organisations such as the Cancer Association of South Africa (CANSA) and the Treatment Action Campaign (TAC) have called on the SA government to do the same.
Both GSK and MSD have expressed a willingness to negotiate with government on a lowered price for public roll-out.
(Wilma Stassen, Health24, December 2008)
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