According to a study published in the current issue of the journal Cancer Prevention Research, aspirin should be assessed for its ability to prevent cervical cancer developing in women infected with HIV.
Aspirin has the potential to provide considerable benefit for women in Africa, the Caribbean and Latin America, regions where death rates from cervical cancer are extremely high.
The study was conducted by global health investigators at New York-Presbyterian Hospital/Weill Cornell Medical Center and cancer specialists in New York, Haiti and Qatar.
In Haiti, this easy and cheap solution could be particularly useful, as invasive cervical cancer is a prevalent cause of death among women infected with HIV. In addition, Haiti has one of the highest HIV infection rates in the Western Hemisphere, as well as the highest reported incidence of cervical cancer in the world.
Dr. Daniel Fitzgerald is the lead researcher of the study and an associate professor of medicine at Weill Cornell Medical College. He lived in Haiti for 7 years, continues to treat individuals with HIV in the country, and is a key member of the Weill Cornell Medical College Center for Global Health. Fitzgerald directs the College’s collaboration with GHESKIO, a Haitian non-governmental organization that provided clinical service, training and research in HIV/AIDS since 1980.
He explained:
“These young patients – many of whom were mothers and the sole support for their families – had worked hard to have their HIV controlled with antireviral therapy, only to develop and die from cervical cancer.
The results of this collaborative effort will make a real difference for women living in one of the poorest nations in the world. It is wonderful that clinicians and scientists from different parts of the world were able to come together to address such a critical issue of care.”
While examining cervical tissue samples from Haitian HIV-Infected women, the investigators found that the disease activates expression of the COX-2/prostaglandin E2 (PGE2) inflammatory pathway.
The findings link HIV (which causes chronic inflammation) and PGE2 (which is elevated during inflammation) to cancer development in several tumor types, including cervical cancer.
According to the researchers, the finding that HIV increases PGE2 production in cervical tissue was unknown prior to this investigation.
This finding might explain why the risk of developing invasive cervical cancer is 5 times higher in women infected with the disease than HIV-negative women. Furthermore, it indicates that inhibitors of the COX-2 molecule (which contributes to the generation of PGE2) may destroy the association between cervical cancer and HIV. One of the most effective and inexpensive COX inhibitors available is Aspirin.
Dr. Andrew Dannenberg, director of the Weill Cornell Cancer Center at New York-Presbyterian/Weill Cornell and the Henry R. Erle, M.D., – Roberts Family Professor of Medicine at Weill Cornell Medical College, and senior editor for Cancer Prevention Research, said:
“The findings in this study provide new insights into the link between viral infection and inflammation, two known drivers of cancer development.
Future studies will be needed to determine whether aspirin-like agents, known inhibitors of prostaglandin production, can reduce the risk of cervical cancer in this high-risk population.”
In three groups of women, the team analyzed COX-2 and PGE-M (a stable metabolite of PGE2) levels and found that in 13 women who were infected with HIV and HPV, levels of COX-2 and PGE-M were elevated. In addition, levels of both molecules were increased in 18 HIV-infected women who tested negative for HPV, while levels among 17 HIV-negative women not infected with HPV were lowest.
Dr. Fitzgerald explained that the findings show that HIV is linked to increased cervical COX-2 and increased systemic PGE2 levels. Women infected with both HIV and HPV are at increased risk of developing cervical cancer. Further investigations will aim to define which women may benefit from daily aspirin use or associated inhibitors.
The clinical research program was set up by Dr. Fitzgerald and Dr. Cynthia Riviere, GHESKIO physician and co-author of the study, in order to care and prevent cervical cancer in HIV-infected women in Haiti after they found an increasing report of cases.
Dr. Jeremie Arash Rafii Tabrizi, assistant professor of genetic medicine at Weill Cornell Medical College in Qatar, who has treated women at the GHESKIO clinic, said:
“The goal is to give patients in Haiti the same standard of treatment found in any cancer center. We are focusing on procedures that will allow for a reduction of morbidity – as this is a major concern in this population – as well as a reduction of risk of recurrence.”
The study received funding from the National Cancer Institute, the Flight Attendant Medical Research Institute, and the Fogarty International Center.
Other co-authors include Karl Bezak, Oksana Ocheretina, Xi Kathy Zhou, Baoheng Du, Kotha Subbaramaiah, Erin Byrt and Matthew L. Goodwin, all from Weill Cornell; Thomas C. Wright from Columbia University College of Physicians and Surgeons; and Ginger L. Milne from Vanderbilt University School of Medicine.
Written by Grace Rattue