The impact of HIV infection on cervical cancer presentation and survival in Uganda

OBJECTIVES

To determine how HIV infection impacts cervical cancer stage and overall survival (OS) among Ugandan women.

METHODS/MATERIALS

Women diagnosed with cervical cancer were followed between 2013 and 2015 at the Uganda Cancer Institute (UCI). A Poisson regression model was fit to calculate prevalence ratios (PR) for the association between HIV infection and late stage at cancer diagnosis. The association between HIV infection and OS after cervical cancer diagnosis was evaluated using a Cox proportional hazards model.

RESULTS

53 HIV-positive and 96 HIV-negative participants were enrolled. Median age at diagnosis was 44 years (IQR 39-48) for HIV-positive and 54 years (IQR 47-62) for HIV-negative participants. 77% of HIV-positive participants were receiving antiretroviral therapy. Median baseline CD4 count was 373 cells/mm3 (IQR 300-502) for HIV-positive participants versus 926 cells/mm3 (IQR 639-1045) for HIV-negative participants. Thirty-two percent of HIV-positive participants were diagnosed with late stage cervical cancer (III-IV) versus 39% of HIV-negative participants (p=0.4). After adjusting for age, number of live births, and cost of transportation, no association was found between late stage at cancer diagnosis and HIV status (PR 1.03, 95%CI 0.60-1.78, p=0.9). Most women presenting for care received treatment (85% of HIV-positive versus 75% of HIV-negative), though almost half who received radiotherapy did not receive adequate treatment. There were 35 deaths among HIV-positive and 45 among HIV-negative participants. The median OS was significantly shorter for HIV-positive participants (14.7 months vs 24.3 months for HIV-negative participants, p=0.05). After adjusting for age and stage, HIV infection was weakly, but not statistically significantly, associated with OS (HR 1.35, 95%CI 0.83-2.17).

CONCLUSIONS

Cervical cancer remains morbid and often incompletely treated in Uganda. HIV infection was not associated with the stage of cervical cancer at diagnosis, but may be weakly associated with shorter survival, although our limited sample size prohibits definitive statistical evidence.