Clinical Manual for Management of the HIV-Infected ... - myCME.com

Patient Education
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Patients who smoke should be advised to quit.
Cigarette smoking appears to heighten the risk of
cervical cancer, and makes HPV more difficult to
treat. Discuss options for smoking cessation, and
refer patients to the American Lung Association if
programs are available in your area.
Recommend the use of latex or polyurethane male
or female condoms for vaginal or anal intercourse
and plastic or latex barriers for oral sex to reduce the
risk of transmitting HPV (the usual cause of cervical
cancer) to partners. Barriers will also reduce the risk
of exposure to other sexually transmitted pathogens.
Emphasize the importance of keeping follow-up
appointments for Papanicolaou smear or colposcopy
to allow early detection of precancerous lesions and
appropriate monitoring of abnormalities.
For women with dysplasia who require treatment,
emphasize that early treatment is essential to
manage the disease and prevent the development
of cancer. Advise patients to keep all medical
appointments.
References
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Section 6—Disease-Specific Treatment | 6–15
Abularach S, Anderson J. Gynecological Problems. In:
Anderson JR, ed. A Guide to the Clinical Care of
Women with HIV. Rockville, MD: Health Services
and Resources Administration; 2001:153. Available
online at hab.hrsa.gov/publications/womencare05/.
Accessed June 16, 2006.
Centers for Disease Control and Prevention,
National Institutes of Health, HIV Medicine
Association/Infectious Diseases Society of America.
Treating Opportunistic Infections Among HIV-Infected
Adults and Adolescents. MMWR Recomm Rep.
2004 Dec 17; 53(RR15);1-112. Available online
at aidsinfo.nih.gov/Guidelines/GuidelineDetail.
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Ellerbrock TV, Chiasson MA, Bush TJ, et al.
Incidence of cervical squamous intraepithelial
lesions in HIV-infected women. JAMA. 2000 Feb
23;283(8):1031-7.
Massad LS, Ahdieh L, Benning L, et al. Evolution
of cervical abnormalities among women with HIV-
1: evidence from surveillance cytology in the women’s
interagency HIV study. J Acquir Immune Defic Syndr.
2001 Aug 15;27(5):432-42.
Newman, M. Women and HIV. In: Peiperl L, Coffey
S, Volberding PA, eds. HIV InSite Knowledge Base
[textbook online]. San Francisco: UCSF Center for
HIV Information; March 2004. Available online at
hivinsite.ucsf.edu/InSite?page=kb-03&doc=kb-03-
01-12. Accessed June 1, 2006.
Solomon D, Davey D, Kruman R, et al. The
2001 Bethesda System: terminology for reporting
results of cervical cytology. JAMA. 2002 Apr
24;287(16):2114-9.
U.S. Public Health Service, Infectious Diseases
Society of America. 2002 Guidelines for preventing
opportunistic infections among HIV-infected persons.
MMWR Recomm Rep. 2002 Jun 14;51(RR08);1-
46. Available online at aidsinfo.nih.gov/Guidelines/.
Accessed June 1, 2006.
Wright TC, Cox JT, Massad LS, et al. 2001
Consensus Guidelines for the management of women
with cervical cytological abnormalities. JAMA. 2002
Apr 24;287(16):2120-9.