Differences in outcomes of chemoradiation in women with invasive cervical cancer by HIV status: a systematic review.

Abstract Background Cervical cancer is one of the leading causes of cancer death among women worldwide and women living with HIV carry the highest burden of disease. Chemoradiation (CRT) is the current standard treatment for locally advanced cervical cancer, without specific treatment modifications based on HIV status. This systematic review evaluates existing literature reporting differences in outcomes between HIV-positive and HIV-negative women with invasive cervical cancer treated with CRT. Methods Searches were conducted through Pubmed, Ovid MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Two researchers independently conducted article selection; articles were selected by title, then abstract, and then by full text content. Data were extracted using a structured form. Results Thirteen articles were included in the analysis, all of which were either retrospective or prospective cohort studies published between 2012 and 2018, and most of which were conducted in Sub-Saharan Africa. Treatment outcomes included treatment response, survival, toxicities, and quality of life. The majority of studies (eight of thirteen) reported no differences in treatment outcomes by HIV status. Out of eight studies that assessed survival, six reported no significant difference based on HIV status. All four studies assessing treatment response found no significant differences based on HIV status. Among six studies primarily assessing treatment toxicity, three showed no differences based on HIV status. Factors affecting treatment outcomes, such as treatment selection bias, pre-treatment hemoglobin levels, and ART administration, were not systematically accounted for. Conclusion The majority of studies analyzed showed no differences in treatment outcomes, including overall toxicity, treatment response, or mortality, on the basis of HIV infection status. These results suggest CRT should continue to be the treatment of choice for locally invasive cervical cancer regardless of HIV status. Further study is required to more precisely account for other variables that influence treatment outcome.