Chemoradiotherapy completion and neutropenia risk in HIV patients with cervical cancer

Abstract

Cervical cancer (CC) is one of the acquired immunodeficiency syndrome (AIDS) defining diseases and the human immunodeficiency virus (HIV) infection is thought to relate with increased acute toxicity of chemoradiotherapy (CRT).We investigated the effect of HIV status in the incidence of neutropenia associated with cisplatin-based CRT for CC and its impact in treatment completion.This is a single-center retrospective cohort study. Data collection was performed for all the consecutive stage Ib-IV CC women treated with cisplatin-based CRT from 2012 to 2016, and with known HIV status.Sixty-one patients were included, 6 were HIV+. HIV+ patients had a higher risk of neutropenia at any cycle during cisplatin CRT [adjusted odds ratio (OR) 7.3, 95% confidence interval (95% CI) 1.02–52.3; P = .05]. Despite the absolute differences, mean neutrophil count was nonsignificantly lower in HIV+ women, both at baseline [4455/μL (interquartile range, IQR: 1830–6689) vs 6340 (IQR: 1720–18,970) for HIV−, P = .98] and at the end of treatment [1752/μL (IQR: 1100–2930) vs 3147/μL (IQR: 920–18,390) in HIV−; P = .06]. Moreover, when considering the effect of time, CRT seems to induce a consistent drop of neutrophils in both groups (P = .229). No febrile neutropenia events occurred.In HIV+ women, there were more CT cycle delays (P = .013), patients were more prone to use granulocyte colony-stimulating factor (G-CSF; HIV+ 40.0% vs HIV− 4.0%; P = .04) and less likely to complete at least 5 cycles of cisplatin (P = .02). All patients received adequate dose of pelvic RT, regardless of HIV status.HIV+ patients have a significantly increased risk of neutropenia during CRT treatment for CC and are less likely to complete chemotherapy with cisplatin.

Analysis of the effects of mEHT on the treatment-related toxicity and quality of life of HIV-positive cervical cancer patients

“…In our study, HIV infection was associated with an increased rate of RT delays; however, it was not a predictor of RTrelated toxicities as reported in the literature [19,58,59]. The increased rate of renal toxicity in HIV-positive participants treated with mEHT, and decreased rate of renal toxicity in HIV-negative participants treated with mEHT, compared to the control group, is an unexpected result.…”

Immune correlates of therapy outcomes in women with cervical cancer treated with chemoradiotherapy: A systematic review

“…These results suggest that CRT itself should not specifically affect immune function in HIV disease. However, intensified neutropenia has also been observed in WLWH in several separate studies 67,69 …”

“…Importantly, most of the WLWH in the published studies were immunologically stable on ART with suppressed viremia, 67,69,70 although one group found that four patients (14%) had an increased HIV viral load after CRT, with two patients on ART and two not on ART 68 . Generally, viral suppression while taking ART portends successful completion of therapy; for example, the AIDS‐Malignancy‐Consortium‐081 study found that 82% of WLWH were able to complete anti‐cancer therapy 70 .…”

“…However, intensified neutropenia has also been observed in WLWH in several separate studies. 67 , 69 …”

HIV-Associated Anal Cancer

“…HIV-positive patients undergoing treatment were more frequently hospitalized within 90 days of treatment for acute toxic effects, in particular, for hematological toxicities [ 21 ]. Chemotherapy also exacerbates a neutropenia that already exists in HIV/AIDS patients, which can be ameliorated by granulocyte colony-stimulating factors (G-CSF) [ 32 ]. However, these drugs are not to be administered concurrently with chemoradiotherapy [ 33 ].…”