Expertos Invitados





NEOPLASIA CERVICAL Y PACIENTES INFECTADAS POR HIV

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La observación cercana continua, asociada con por lo menos un examen citológico anual, y el tratamiento adecuado, en caso de una lesión escamosa intraepitelial de alto grado, son de suma importancia.
stier9.jpg Autor:
Elizabeth Stier
Columnista Experto de SIIC

Institución:
Assistant Attending Surgeon General Gynecology Section Gynecology Service Department of Surgery Memorial Sloan-Kettering Cancer Center New York, USA

Artículos publicados por Elizabeth Stier
Recepción del artículo
22 de Octubre, 2004 		Aprobación
5 de Noviembre, 2004
Primera edición
5 de Julio, 2005 		Segunda edición, ampliada y corregida
7 de Junio, 2021

NEOPLASIA CERVICAL Y PACIENTES INFECTADAS POR HIV

Resumen
El propósito de esta revisión es resumir los estudios existentes sobre la infección cervical por el virus del papiloma humano (HPV) y la neoplasia cervical intraepitelial (CIN) en las mujeres infectadas por el virus de la inmunodeficiencia humana (HIV). Además, esta revisión discute el manejo del extendido de Papanicolaou (Pap) anormal y las recomendaciones de tratamiento para la displasia cervical en las pacientes infectadas por el HIV. La infección por HPV y la CIN están claramente incrementadas en las mujeres HIV positivas, en comparación con las mujeres HIV negativas de riesgo equiparable. Cualquier Pap anormal debería ser investigado con detenimiento, mediante evaluación colposcópica. El tratamiento es recomendable en los casos de CIN 2-3. Sin embargo, los índices de recurrencia luego del tratamiento son muy altos. Las repercusiones del tratamiento antirretroviral de gran actividad (TARGA) sobre la incidencia de la infección por HPV, la displasia cervical y el índice de recurrencia luego del tratamiento no son todavía claras. La información vigente sugiere que debería continuar la práctica de la detección sistemática del cáncer cervical y el tratamiento de las lesiones cervicales de alto grado en las pacientes HIV positivas, aun entre las mujeres que han respondido adecuadamente a la TARGA.

Palabras clave
Papilomavirus humano, virus de la inmunodeficiencia humana, cáncer de cuello uterino, terapia antirretroviral de gran actividad, neoplasia cervical intraepitelial


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CERVICAL NEOPLASIA AND THE HIV-INFECTED PATIENT

Abstract
The purpose of this review is to summarize studies of cervical human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in HIV-infected women. In addition, this review discusses management of the abnormal Pap smear and treatment recommendations for cervical dysplasia in the HIV-infected patient. Cervical HPV infection and CIN are clearly increased in HIV-positive women when compared with risk-matched HIV-negative women. Any abnormal Pap smear should be further investigated with a colposcopic evaluation. Treatment is recommended for CIN2-3. However, recurrence rates after treatment are very high. The impact of highly active antiretroviral therapy (HAART) on the incidence of HPV infection, cervical dysplasia, and recurrence rate after treatment is not yet clear. Current data suggest that cervical cancer screening and treatment of high-grade cervical lesions in HIV-positive women should continue, even in women who have responded well to HAART.

Key words
Human papillomavirus, human immunodeficiency virus, cervical cancer, highly active antiretroviral therapy, cervical intraepithelial neoplasia


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Artículos originales > Expertos del Mundo >
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Especialidades
Principal: Infectología, Obstetricia y Ginecología
Relacionadas: Anatomía Patológica, Atención Primaria, Diagnóstico por Laboratorio, Medicina Familiar, Medicina Interna, Oncología, Salud Pública



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Stier, Elizabeth
Bibliografía del artículo
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