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HIV status does not preclude receipt of curative cervical cancer therapy in Botswana

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February 25, 2019

Women in Botswana with well-managed HIV had the same access to curative chemoradiotherapy for cervical cancer as women without HIV, according to results of an observational study published Cancer.

The results show baseline hemoglobin level, disease stage and age — not HIV status —significantly predicted curative treatment initiation in the African country, where cervical cancer is the leading cause of cancer death and HIV prevalence exceeds 34% among women aged 25 to 45 years.

“It remains controversial whether women who have cervical cancer with HIV infection have outcomes similar to those of women who have cervical cancer without HIV infection,” Surbhi Grover, MD, MPH, assistant professor of radiation oncology at Hospital of the University of Pennsylvania, and colleagues wrote. “Although some studies suggest that HIV infection may be associated with decreased survival, our previous findings in Botswana have suggested that patients with HIV infection who initiated chemoradiation treatment with curative intent have outcomes similar to those of patients without HIV infection.”

The study included 519 women with locally advanced cervical cancer in Botswana who initiated either curative-intent chemoradiotherapy (n = 284) or noncurative treatment (n = 235).

The curative-intent group included 200 women (70.4%) living with HIV who had a median CD4 count of 484 cells/µL (interquartile range [IQR] = 342-611). The noncurative group included 157 women living with HIV who had a median CD4 count of 476.5 cells/µL (IQR = 308-649.5).

Results showed no association between HIV status and initiation of curative chemoradiotherapy (OR = 0.95; 95% CI, 0.58-1.56). Rather, factors associated with increased likelihood of starting the treatment included baseline hemoglobin levels of at least 10 g/dL (OR = 1.8; 95% CI, 1.18-2.74) and stage 1 or stage 2 disease compared with stage 3 or stage 4 disease (OR = 3.16; 95% CI, 2.1-4.75).

Among women with HIV in both cohorts, higher CD4 cell counts were associated with higher rates of chemoradiotherapy. Women aged older than 61 years appeared less likely to receive curative treatment (OR = 0.43; 95% CI, 0.24-0.75).

A lack of data from women who were unable to show up for treatment served as a limitation to the study.

“These results demonstrate that women living with well-managed HIV infection are not preferentially prescribed noncurative treatment,” Grover and colleagues wrote. “In concert with our previous findings demonstrating that treatment outcomes in cervical cancer do not depend on HIV status, the current analysis has potential implications for the treatment of patients with cancer who are living with well-managed HIV around the globe.”

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In an accompanying editorial, Richard F. Little, MD, of the division of cancer treatment and diagnosis at the NCI, said that the rest of the world should take note of the study’s implications regarding HIV-associated cancer prevention and therapies.

“The simple message of this paper is that if people with HIV infection are immediately given access to modern HIV therapy, and if they have cancer and are treated with the community standards for the best cancer therapy, the outcome differences between those with and without HIV infection can be minimized,” Little said in a press release. “I believe the research serves as an important example on how treatment disparities can be reduced and hope that the approach to HIV and cancer around the world can become more like it is Botswana: treat the HIV and give the best cancer therapy available, and also open up cancer clinical trials to people living with treated HIV.” – by John DeRosier

Disclosures: Grover and Little report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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