Objectives: Cervical cancer (CC) is one of the human immunodeficiency virus (HIV)-related cancers. The objective of this retrospective observational cohort study was to explore the treatment response, survival, and independent prognostic predictors for HIV-positive patients with CC. Design/Participants/Materials/Setting/Methods: This is a retrospective case-control study. Patients with primary CC, treated at Xiangyang Central Hospital, Hubei, China, from June 2013 to June 2019, were reviewed. All included patients were divided into the HIV-positive and HIV-negative groups. The primary outcome was overall survival (OS). A Kaplan-Meier curve was used to evaluate the survival condition. Univariate and multivariate Cox proportional hazard regression was used to determine the prognostic predictors for HIV-positive CC patients.
Results: A total of 1,319 patients were included in the study, with 30 in the HIV-positive group and 1,289 in the HIV-negative group. The HIV-negative group had statistically better OS than the HIV-positive group (hazard ratio [HR] 2.68, 95% confidence interval [CI]: 1.78-4.04, p < 0.001). The recurrence rate of HIV-negative was lower than that of HIV-positive patients (p < 0.001). Concurrent radiotherapy and chemotherapy seemed to be less effective for HIV-positive patients than for HIV-negative patients among nonsurgical treatment patients (p = 0.046). The independent predictors for HIV-negative patients were recurrence (HR 3.08, 95% CI: 1.17-8.13, p = 0.023) and CD4 count ≥410/μL (HR 1.84, 95% CI: 1.07-3.19, p = 0.040).
Limitations: First, some potential confounding factors, such as HIV-related co-infections, cannot be avoided, which may decrease the power of our findings. Second, as the sample size of HIV-positive CC patients was relatively small, the baseline characteristics of the two groups were not balanced, which can cause bias in the results to some degree. Finally, some useful data for the analyses were missing for some cases in the present study, which is inevitable for a retrospective study.
Conclusion: There is a significantly lower survival and higher recurrence rate in CC patients with HIV infection, compared with those without HIV infection. Furthermore, inoperable HIV-positive CC patients are less likely to benefit from concurrent radiotherapy and chemotherapy than HIV-negative patients. Recurrence and blood CD4 count are independent prognostic factors for HIV-positive CC patients.
Keywords: CD4; Cervical cancer; Chemoradiotherapy; Human immunodeficiency virus; Prognosis; Surgery; Survival.
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