Five-year overall survival following chemoradiation therapy for locally advanced cervical carcinoma in women living with and without HIV infection in Botswana

Jessica M George,Emily Macduffie,Sebathu Chiyapo,Shawna Tuli,Doreen Ramogola-Masire,Nicola M Zetola,Surbhi Grover,Memory Bvochora-Nsingo,Allison Chambers,Dawn Balang,Lilie L Lin

doi:10.1186/s13027-021-00389-w

Abstract

PurposeTo compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting.Methods & MaterialsWomen in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up.ResultsThis cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001).ConclusionsFive-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.

Highlights

Cervical cancer is the fourth most common cancer in women in terms of both incidence and mortality, with 85% of disease burden falling on women in low- and middle-income countries [1]
Since initiating a publicly-funded antiretroviral therapy (ART) program in 2002, an aging population living with human immunodeficiency virus (HIV) infection has emerged in Botswana, and, subsequently, the incidence of cervical cancer has increased by 3.0% annually [5]
Baseline hemoglobin significantly differed between women living with HIV (WLWH) and without HIV infection (p = 0.04), with 10.6 g/dL (95% confidence interval (CI), 9.2–12.1) and 11.3 g/dL, respectively

Summary

Introduction

Cervical cancer is the fourth most common cancer in women in terms of both incidence and mortality, with 85% of disease burden falling on women in low- and middle-income countries [1]. In Botswana, a middle-income country in sub-Saharan Africa (SSA), cervical cancer is the leading cancer type in females in terms of both incidence and mortality [1]. Since initiating a publicly-funded antiretroviral therapy (ART) program in 2002, an aging population living with HIV infection has emerged in Botswana, and, subsequently, the incidence of cervical cancer has increased by 3.0% annually [5]. The potential effects of HIV infection on cervical cancer survival and treatment toxicity, were previously poorly described. We have sought to elucidate these potential effects by prospectively comparing a cohort of WLWH receiving chemoradiation (CRT) to those without HIV infection receiving the same treatment in Botswana

Methods

Results

Discussion

Conclusion