Five-year overall survival following chemoradiation among HIV-positive and HIV-negative patients with locally advanced cervical carcinoma in a South African cohort

Abstract

ObjectivesIn South Africa, where HIV prevalence among adults is 18.9%, cervical carcinoma is the second most common malignancy in women. However, oncology services are considerably more accessible in South Africa than in many neighbouring countries.This study reports five-year overall survival in a cohort of HIV-positive and -negative cervix carcinoma patients undergoing primary radiotherapy at a single institution in South Africa. MethodsProspective cohort study of all locally advanced cervix carcinoma patients referred for radiotherapy (EBRT) from July 2007 to November 2011. Overall survival (OS) was the primary end-point. ResultsA total of 492 patients commenced treatment with radical intent, including 71 HIV-positive patients (14.4%) and 421 HIV-negative patients (85.6%). Of the 433 who were prescribed standard fractionation EBRT, 384 were prescribed concurrent platinum-based chemotherapy (88.7%). Fewer HIV-positive than HIV-negative patients (58.5% vs. 76.1%; p = 0.007) completed ≥4 cycles. The OS of HIV-negative patients was 49.5% (95%CI; 44.6%–54.4%) at 5 years. The OS of HIV-positive patients was significantly lower, 35.9% (95% CI; 23.9%–48.0%) at 5 years (p = 0.002). In our Cox models, factors affecting outcome were HIV infection, stage IIIB disease, presence of hydronephrosis, and delivery of concurrent chemotherapy. ConclusionIn our large cohort, HIV-positive patients had poorer survival than HIV-negative patients, however nearly 40% survived 5 years, justifying provision of the best standard of care to HIV-positive patients with cervical carcinoma.