Human Immunodeficiency Virus Infection and Invasive Cervical Cancer in South Africa

Purpose: The goal of this study was to determine whether South African HIV-seropositive women with invasive cervical cancer present with disease that is more advanced than that of HIV-seronegative women and whether degree of immunosuppression affects the extent of disease at initial presentation.

Methods: This study is a retrospective review of 60 HIV-seropositive and 776 HIV-seronegative new cases of invasive cervical carcinoma seen at the combined gynecologic oncology unit of the University of the Witwatersrand, Johannesburg, South Africa.

Results: The HIV seroprevalence was 7.2%. Squamous cell carcinoma was the histologic subtype in more than 90% of both cohorts of patients. Although the HIV-positive patients presented with invasive cervical cancer almost 10 years earlier than the HIV-negative patients, i.e., mean age 44 years +/- 9.8 versus 53 years +/- 12.7, respectively (P </= 0.001), there was no difference in the distribution of advanced lesions in the two groups, i.e., 65% in HIV-positive and 55.4% in HIV-negative patients (P = 0.177). At initial diagnosis 26 of the HIV-seropositive patients had a CD(4) cell count less than 200/mm(3), 20 (77%) of whom presented with stage III or IV cervical cancer; the remaining 34 had a CD(4) cell count above 200/mm(3), 19 (56%) of whom had advanced-stage disease. This was not significantly different (P = 0.109). However, HIV-seropositive patients with CD(4) cell counts less than 200/mm(3) had significantly more advanced-stage disease than HIV-seronegative patients, i.e., 77% versus 55.8% respectively (P = 0.041).

Conclusion: HIV-seropositive patients presented with invasive cervical cancer almost 10 years earlier than HIV-seronegative patients. Even though HIV seropositivity on its own did not appear to adversely affect extent of disease at presentation, patients with CD(4) cell counts below 200/mm(3) are significantly more likely to have advanced-stage disease at initial diagnosis than HIV-negative patients.