AEGiS-15IAC: Outcome of treatment for invasive cervical cancer with concurrent HIV infection.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Outcome of treatment for invasive cervical cancer with concurrent HIV infection.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1405)

Gichangi P, Estambale B, Bwayo J, Rogo K, Opiyo A, Njuguna E, Abwao H, Ojwang S, Temmerman M
University of Nairobi, Nairobi, Kenya

BACKGROUND: Cervical cancer patients with concurrent HIV infection have a short survival of about 10-months despite appropriate treatment. It is ill understood how HIV infection confers such as adverse effect on treatment outcome of cervical cancer. OBJECTIVE: To determine external beam radiotherapy (EBRT) treatment outcome for cervical cancer patients with concurrent HIV infection.

METHOD: 208 patients receiving EBRT were prospectively evaluated for acute toxicity and pelvic tumor control. HIV test was done. Clinical evaluation was used to document pelvic tumor control. Multivariate analysis was used to determine the effect of HIV on acute morbidity and pelvic tumor control. Clinicians were blinded for HIV results.

RESULTS: About 20% (41/208) of the patients were HIV positive but asymptomatic for HIV infection. Overall, 53.4% of the patients had radiation related acute toxicity (grade 3-4). HIV infection was associated with a 7-fold higher risk of multisystem toxicity: skin, GIT and GUT systems. It was also an independent risk factor for treatment interruptions (ARR 2.2). More HIV positive patients had pretreatment hemoglobin<10g/dl than HIV negative patients (63% vs 38%, p=0.004). About 19% of the patient had residual tumor at 4-7 months post EBRT. In a multivariate analysis HIV infection was independently and significantly associated with 6-fold higher risk of residual tumor (ARR 6.2) after EBRT. The hazard ratio of residual tumor after initial EBRT was 3.1-times larger for HIV positive than for HIV negative patients, (p=0.014). Conclusion HIV infected patients have a significantly increased risk of multisystem radiation-related toxicity, treatment interruptions and residual tumor following EBRT. These results suggest that HIV infection is an adverse prognostic factor for adverse outcome of cervical cancer treatment. These data suggest that HIV infected cervical cancer patients are special group, which needs individualized radiation treatment planning.

Keywords: AEGIS, HIV Infections, Cervix Neoplasms, HIV Seropositivity, Risk Factors, Acquired Immunodeficiency Syndrome, Neoplasm, Residual, Radiation Injuries, Female, Humans, therapy

040711
ThOrB1405