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Study Finds HIV Infection Linked to Reduced Survival Among Women With Cervical Cancer in Botswana

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Key Points

  • HIV infection was associated with significantly poorer survival in women with cervical cancer in Botswana.
  • An increased risk of death was observed in HIV-infected women who received guideline-concordant curative treatment for cervical cancer.

Despite access to and use of antiretroviral therapy, HIV (human immunodeficiency virus) infection was associated with reduced survival in women with cervical cancer in Botswana, according to a study reported by Dryden-Peterson et al in the Journal of Clinical Oncology.

Study Details

The study involved 348 sequential women with invasive cervical cancer in Botswana from 2010 to 2015. Standard treatment included external-beam radiation and brachytherapy with concurrent cisplatin chemotherapy. HIV therapy was provided without cost at government clinics. Analyses included 327 women with a known HIV status, including 231 (66.4%) with HIV infection and 96 (27.6%) without HIV infection.

Antiretroviral therapy was started before the diagnosis of cervical cancer in 81.8% of women, with most having been on therapy for several years. Median CD4-positive cell count for women with HIV was 397/µL.

Survival Outcomes

During median follow-up of 19.7 months, death occurred in 117 women with HIV (50.7%) and 40 women without HIV (41.7%). Only one death was attributed to HIV, with the remaining deaths attributed to cancer. Overall survival at 3 years was 35% vs 48%.

In an analysis adjusting for numerous potential confounding factors, HIV infection was significantly associated with an increased risk of death among all women (hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.20–3.17) and among women who received guideline-concordant curative treatment for cervical cancer (HR = 2.63, 95% CI = 1.05–6.55). The detrimental effect of HIV on survival was significant among women with more limited-stage cancer (P = .035), those treated with curative intent (P = .003), and those with a lower CD4-positive cell count (P = .036).

The investigators concluded: “In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.”

The study was supported by the National Institutes of Health, the National Cancer Institute, and the Paul G. Allen Family Foundation.

Scott Dryden-Peterson, MD, of the Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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