AIDS (London, England) 2017 10 12() doi 10.1097/QAD.0000000000001664
To evaluate gynecologic cancer treatments in Human Immunodeficiency Virus (HIV) infected women for adherence to National Comprehensive Cancer Network (NCCN) guidelines and to describe survival by adherence to guidelines.
Beyond cervical cancer, there is little data on treatment and outcomes for these women. This is a retrospective cohort study of HIV infected women with gynecologic cancers.
HIV infected women with gynecologic cancers from 2000-2015 were identified at two urban, comprehensive cancer centers. Chart reviews extracted demographic, HIV, and cancer-related variables. Cancer treatment was evaluated for adherence to NCCN guidelines. Overall survival was compared between those who received NCCN adherent and non-adherent cancer care.
Fifty-seven women were identified; 15 vulvar (26%), 26 cervical (46%), 9 ovarian (16%), and 7 endometrial (12%) cancers. Median time from HIV to cancer diagnosis was 8.5 years, and 88% of women were black. Thirty patients (53%) had stage I, and 27 (47%) had stage II-IV disease. Overall 28 women (49%) received NCCN adherent care; 22/30 stage I (73%) and 6/27 stage II-IV patients (22%). Among 29 women not receiving NCCN adherent care, 69% were due to patient-related factors or toxicity. Among women with II-IV cancers, 48 month survival was higher in women who received NCCN-adherent care than those who did not (60% versus 28%).
Most HIV infected women with advanced gynecologic cancers did not receive NCCN-adherent care and had worse survival compared to those who did. Focus on treatment-related toxicities and patient-related barriers to cancer care are necessary in this population.