US researchers find favourable trends among women with HIV in response to cervical cancer therapy

Since the recognition of the HIV pandemic in the 1980s, one of the complications faced by women with HIV has been invasive cervical cancer. The cause of this cancer is a common sexually transmitted virus called human papillomavirus (HPV). Regular screening for cervical lesions (the precursor of cervical cancer) is an important part of care for women with HIV. It is also important for women with HIV to discuss HPV vaccination with their care provider (if they have not already been vaccinated).

A team of researchers across seven major cancer research centres in the United States recently cooperated, pooling health-related information in their databases to compare data about cervical cancer treatment and its outcomes in cisgender women with and without HIV. The data used for the present analysis was collected between 1997 and 2017. Most cases of cervical cancer (63%) occurred in women between 2009 and 2017.

Researchers enrolled 62 women with HIV and 172 women without HIV of similar age and cervical cancer disease stage at the time of diagnosis and treatment. Participants were monitored for about four years.

Most women were diagnosed when the cancer had spread in the lower part of the vagina and to nearby lymph nodes and, in some cases, the kidney (stage 3).

About 50% of participants underwent chemotherapy and radiation.

Overall, the researchers found that there were no differences in survival among women with HIV who were adherent to ART and who were treated for cervical cancer compared to women without HIV who were treated for cervical cancer.

Women who were not adherent to ART were at heightened risk for dying compared to women with HIV who were adherent to ART or women without HIV. Women who were non-adherent to ART did not respond as well to cervical cancer treatment as other women (those with HIV who were adherent to ART and those without HIV).

The frequency of severe side effects was not affected by HIV status or adherence to ART.

Bear in mind

Although the study was small and had a retrospective design (whereby data in the past collected for one purpose was reanalyzed for another purpose), it did include women from seven leading cancer centres in the U.S. The distribution of different centres with different populations and delivery of care should help to reduce potential biases in the study results.

The research team states that its findings underscore that women with HIV should be treated for cervical cancer with the intention of curing the cancer. Furthermore, the researchers encourage oncologists to stress the importance of adhering to ART during treatment for cervical cancer to help ensure ideal results.

Unfortunately, as with many database-oriented studies, there was no information on why there were adherence challenges to ART among some women with HIV. Therefore, the study also highlights the need for adherence support programs for some women with HIV.

In Canada

A study in Ontario has found that out of 591 women with HIV engaged in care, only about 13% had received at least one vaccination against HPV. Concerted effort is needed to ensure that more women with HIV receive this vaccination so that their risk for cervical cancer can be reduced.

In another study with nearly 1,200 women with HIV in British Columbia, Ontario and Quebec, researchers stated “over one-third of women reported cervical cancer screening delays, and one-quarter had never discussed cervical cancer screening recommendations with a health care provider.”

Much work remains to be done in Canada to help women with HIV stay healthy.

By Sean R. Hosein

Resources

HPV, cervical dysplasia and cervical cancer — CATIE fact sheet

Menopoz & you: A guide to menopause — CATIE

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