HIV Infection Considerably Hurts Chances of Surviving Cervical Cancer, Study Finds

HIV Infection Considerably Hurts Chances of Surviving Cervical Cancer, Study Finds

Cervical cancer patients who are also infected with HIV are at a significantly higher risk of dying than those who do not have the virus, according to a study of cervical cancer patients in Botswana.

The study, “HIV Infection and Survival Among Women With Cervical Cancer,” published in the Journal of Clinical Oncologywas developed by researchers at the Brigham and Women’s Hospital. It shows that HIV infection impacts survival even when cervical cancer patients have good access to antiretroviral treatment.

Cervical cancer is the most common cause of cancer death among African women, a burden intensified by HIV epidemics there. In fact, the incidence of cervical cancer is six times higher in women with HIV infection than the general population.  Despite the expansion of antiretroviral therapy (ART) for HIV, which is thought to reduce the frequency and duration of human papillomavirus (HPV) infections that cause cervical cancer, a drop in the incidence of cervical cancer has not been seen.

This is particularly evident in Botswana, an African country in which 27 percent of the population is infected with HIV. Botswana has one of the best HIV treatment programs in Africa, with HIV treatment coverage and virologic suppression rates that surpass those of high-income countries. But despite remarkable declines in HIV-associated mortality in Botswana, the incidence of cervical cancer has not fallen, and remains among the highest in the world with 36.6 cases per 100,000 women.

Researchers sought to determine the effect of HIV on survival in women in Botswana with cervical cancer. They enrolled 327 people with this cancer, of whom 231 had HIV and 96 did not. The majority of HIV-infected patients had started ART before their cervical cancer diagnosis, with a median treatment duration of 4.8 years.

About 20 months later, a follow-up found that 157 study participants (48 percent) had died, one person of HIV complications and the others of cancer. The mortality rate among those with HIV was higher than among patients without HIV infection (50.7% vs. 41.7%). Results also revealed that the three-year survival rate was 35% for women with HIV, and 48% for women without HIV.

After adjusting for confounding variables, the researchers found that HIV infection was associated with nearly two-fold increased risk of death among women with cervical cancer. Importantly, this risk was even higher, 2.63-fold, among women who received curative treatment for their cancer, which includes a combination of external beam radiation therapy (EBRT), brachytherapy, and chemotherapy.

Investigators also showed that the adverse effect of HIV on survival was higher in women with a limited stage cancer, and in women with lower levels of CD4-positive immune cells.

“Improved treatment approaches for women with HIV-associated cervical cancer and novel retention strategies for all women are urgently needed to address the rising burden of cervical cancer in subSaharan Africa and other low-income regions,” Scott Dryden-Peterson and colleagues wrote.

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Inês Martins holds a BSc in Cell and Molecular Biology from Universidade Nova de Lisboa and is currently finishing her PhD in Biomedical Sciences at Universidade de Lisboa. Her work has been focused on blood vessels and their role in both hematopoiesis and cancer development.

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