Appropriate diagnosis and treatment of gynecological cancers in people living with human immunodeficiency virus (HIV) remains a clinical challenge given rapid changes in both HIV and cancer management and a lack of prospective clinical trial data inclusive of the HIV population. A semi-systematic literature review was performed to identify published studies addressing risk factors, screening, treatment efficacy, treatment toxicity, and prognosis for people living with HIV diagnosed with gynecological malignancies, with a focus on radiotherapy and cervical cancer, given the relative paucity of literature on uterine, ovarian, and vulvovaginal cancers in people living with HIV. People living with HIV are more likely to be co-infected with human papilloma virus and more likely to develop human papilloma virus-associated malignancies. People living with HIV are less likely to receive cancer treatment compared with HIV-uninfected cancer patients, even after adjusting for differences in clinical features and sociodemographic variables. The literature on cervical cancer outcomes is mixed, with some studies demonstrating that people living with HIV have inferior treatment tolerability, response rates, and survival following chemoradiotherapy, and others showing no difference in these outcomes, particularly in patients receiving antiretroviral therapy. Importantly, even in the series showing inferior outcomes in people living with HIV, there were long-term survivors after administration of curative therapy. Consistent with published cancer management guidelines, people living with HIV diagnosed with gynecological cancers should be treated with standard cancer therapy. Co-management with the patient’s HIV specialist is critical to avoid overlapping toxicities and provide optimal supportive care. The morbidity and mortality caused by gynecologic cancers in this population can be mitigated by early diagnosis, appropriate treatment delivery including inclusion of people with HIV in cancer clinical trials, and diligent HIV management.
- cervical cancer
- ovarian cancer
- uterine cancer
- vulvar and vaginal cancer
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Contributors JF, AR, BL, SK, GS: contributed to study design, literature review, manuscript drafts, figure creation, and final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Potentially pertinent disclosures discussed below: 1. A.F. Rositch was supported, in part, by the NIH/NCI-funded Johns Hopkins Specialized Programs of Research Excellence (SPORE) in Cervical Cancer (P50CA098252-16). 2. Gita Suneja is financially supported by 5 For the Fight, the Huntsman Cancer Institute, and the National Cancer Institute/National Institutes of Health (K08CA228631, P30CA042014, P30CA042014). 3. Brittney Dickey is financially supported, in part, by the T32 Fellowship program (T32CA147832).
Provenance and peer review Commissioned; internally peer reviewed.