Association Between CD4 Count and Chemoradiation Therapy Outcomes Among Cervical Cancer Patients With HIV

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2020 Jun 23

PMID 32568769

Citations 5

Authors

Surbhi Grover

Priyanka Mehta

Qiao Wang

Rohini Bhatia

Memory Bvochora-Nsingo

Sonya Davey

Meera Iyengar

Sidrah Shah

Sanghyuk S Shin

Nicola M Zetola

Affiliations

Soon will be listed here.

Abstract

Background: In Botswana, nearly two-thirds of cervical cancer patients are HIV-positive. This study examined the relationship between CD4 count and chemoradiation therapy outcomes among cervical cancer patients with HIV.

Setting: A prospective cohort study of 231 HIV-positive women with locally invasive cervical cancer was conducted in Gaborone, Botswana from January 2015 to February 2018.

Methods: Primary outcome was survival, defined as time from scheduled end of chemoradiation therapy to death or last contact with patient. Nadir CD4 count was defined as lowest CD4 available before cancer diagnosis. Delta CD4 count was defined as improvement from nadir CD4 to CD4 at cancer diagnosis. Hazard ratio (HR) analyses were adjusted for presenting variables (age, baseline hemoglobin, cancer stage, and performance status) and treatment variables (chemotherapy cycles and radiation dose).

Results: Two hundred thirty-one patients were included in nadir CD4 analysis; 139 were included in delta CD4 analysis. Higher delta CD4 was significantly associated with reduced mortality after adjusting for presenting and treatment variables (CD4 100-249: HR 0.45, 95% CI: 0.21 to 0.95; CD4 ≥250: HR 0.45, 95% CI: 0.20 to 1.02). Higher nadir CD4 showed a trend toward reduced mortality after adjusting for presenting and treatment variables (HR 0.94, 95% CI: 0.84 to 1.06).

Conclusions: Higher delta CD4 (greater improvement from nadir CD4 to CD4 at cervical cancer diagnosis) is significantly associated with lower mortality. Although not statistically significant, data suggest that higher nadir CD4 may reduce mortality. These results reinforce the importance of early HIV diagnosis and antiretroviral therapy initiation, as their effects influence cervical cancer outcomes years later.

Citing Articles

Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria.

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Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review.

Beltran Ponce S, Abunike S, Bikomeye J, Sieracki R, Niyonzima N, Mulamira P JCO Glob Oncol. 2023; 9:e2200218.

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Patient perspectives on delays in cervical cancer screening and follow-up care in Botswana: a mixed methods study.

Rendle K, Ramogola-Masire D, Monare B, Ogden S, Toneff H, Saia C BMC Womens Health. 2022; 22(1):195.

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Castle P, Einstein M, Sahasrabuddhe V CA Cancer J Clin. 2021; 71(6):505-526.

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