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Gynecologic cancer in HIV infected women: treatment and outcomes in a multi-institutional cohort.

Gynecologic cancer in HIV infected women: treatment and outcomes in a multi-institutional cohort.
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Levinson KL, Riedel DJ, Ojalvo LS, Chan W, Azngarita AM, Fader AN, Rositch AF,


Levinson KL, Riedel DJ, Ojalvo LS, Chan W, Azngarita AM, Fader AN, Rositch AF, (click to view)

Levinson KL, Riedel DJ, Ojalvo LS, Chan W, Azngarita AM, Fader AN, Rositch AF,

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AIDS (London, England) 2017 10 12() doi 10.1097/QAD.0000000000001664
Abstract
OBJECTIVE
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.

DESIGN
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.

METHODS
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.

RESULTS
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%).

CONCLUSIONS
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.

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