HIV and cervical cancer: Screening and management at US gynecologic oncology fellowship institutions

This study was conducted to determine HIV screening practices and management of HIV-associated cervical cancer. A questionnaire was distributed to directors of the 31 board-approved (1992) gynecologic oncology fellowships in the United States. From 16 states, 21 programs responded (68%), reporting more than 1909 cervical cancer patients treated in 1992. Fifteen programs reported no known HIV infections among cervical cancer patients, and none reported more than 10. Eleven programs reported an established policy of HIV screening for all women with cervical cancer four had no such policy, and six screened selected patients. Sixteen programs had an infectious disease consultant to assist in managing HIV-infected patients. Some types of otherwise indicated therapeutic procedures for HIV-infected women with cervical cancer would not be performed at 63% of centers, with exenteration being the most commonly cited procedure. The shortened life expectancy of HIV-infected women and the existence of alternative treatments with lower risk of body fluid exposure were the most frequently cited reasons for not performing procedures. Of program directors responding, four identified themselves as thoroughly familiar with the HIV staging criteria of the CDC, eleven as somewhat familiar and six as not familiar. The majority of patients with cervical cancer appear uninfected with HIV, but a diagnosis of HIV infection could cause physicians to modify treatment.