181 O - HIV-related cervical cancer (CA) in Italy; a report of 54 cases from the Italian cooperative group on aids and tumors (GICAT)

The incidence of cervical intraepithelial neoplasias has increased in HIV - infected women, and invasive cervical ca is currently considered an AIDS defining condition. However the natural history of HIV - related cervical ca is still unknown. To better characterize cervical ca in HIV - infected women we evaluated 54 cases, including 35 (65%) carcinoma in situ (Cis) and 19 (35%) invasive ca, collected by the GICAT between January 1986 and June 1995. The median age was 28 years (range 19–38). The majority (70%) of patients (pts) were intravenous drug users and an history of sexual promiscuity and anogertital HPV-disease was reported by 55% and 88% of pts, respectively. At the diagnosis of cervical ca, 59% of pts had asymptomatic HIV - disease or PGL (category A), while 20% had sympotmatic HIV disease for diagnostic for AIDS (category B) and 15% had already a diagosis of AIDS (category C). Overall the mean CD4 cell count was 360 (± 230.8 SD), however the mean CD4 cell count was significantly lower in the Cis group than in the invasive ca group (279 ± 221.7 vs 455 ± 270.4, p = 0.03). All pts had squamous cell neoplasia. Among pts with invasive Ca, 63% had stage I acording to FIGO, 21% stage II and 16% stage III-IV. Pts with Cis received cone biopsy (85%) and cryotherapy or laser therapy (15%), whereas pts with invasive ca were treated with major surgery (S) (53%), radiotherapy (24%) or combination therapy (S-chemotherapy) (23%). Complete remission (CR) occurred in 97% of Cis pts and in 81% of invasive ca pts (p = 0.09); the recurrence rate was similar in the two groups (13% vs 20%, respectively), as well is the incidence of AIDS-associated infections during follow up (52% vs 57%, respectively). Median survival was 66 me for Cis pts and 101 mo for invasive ca pts (p = NS). In conclusion, invasive cervical ca is still occurring in at low rate in pts with HIV-infection in Italy, usually with a relatively good immune function. On the other hand there is a higher prevalence of Cis (65%) emphasizing the importance of integrating gynecological care into medical service for HIV-infected women. Supported by ISS grants.