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Gynecol Oncol Rep. 2019 Nov 19;31:100516. doi: 10.1016/j.gore.2019.100516. eCollection 2020 Feb.

The association between HIV infection and cervical cancer presentation and survival in Uganda.

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Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA 98195, USA.
Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, PO Box 19024, Seattle, WA 98109, USA.
Uganda Cancer Institute, Upper Mulago Hill Road, Kampala, Uganda.
Department of Epidemiology, University of Washington, 1959 NE Pacific St, Box 357236, Seattle, WA 98195, USA.
Department of Medicine, University of Washington, 1959 NE Pacific St, Box 356420, Seattle, WA 98195, USA.
Department of Global Health, University of Washington, 325 9th Ave, Box 359931, Seattle, WA 98104, USA.
Infectious Disease Research Institute, 1616 Eastlake Ave E, Suite 400, Seattle, WA 98102, USA.


Our objective was to determine how HIV infection impacts cervical cancer stage at presentation and overall survival (OS) among Ugandan women. This was a prospective study of 149 women diagnosed with cervical cancer from 2013 to 2015 at the Uganda Cancer Institute. Poisson regression models were fit to calculate prevalence ratios (PR) for the association between HIV infection and late stage at cancer diagnosis. The association between HIV infection and OS after cervical cancer diagnosis was evaluated using Cox proportional hazards models. The cohort included 53 HIV-positive and 96 HIV-negative participants. Median age at diagnosis was 44 years for HIV-positive and 54 years for HIV-negative participants. Seventy-seven percent of HIV-positive participants received antiretroviral therapy. Median baseline CD4 count was 373 cells/mm3 for HIV-positive participants versus 926 cells/mm3 for HIV-negative participants. Thirty-two percent of HIV-positive participants were diagnosed with late stage cervical cancer (III-IV) versus 39% of HIV-negative participants. No association was found between late stage at cancer diagnosis and HIV infection (PR adjusted for age, parity and transport cost 1.0, 95%CI 0.6-1.8). Most women presenting for care received cancer treatment, though almost half who received radiotherapy did not complete treatment. The median OS was 13.7 months for HIV-positive participants and 24.3 months for HIV-negative participants. After adjusting for age and stage, HIV infection was weakly associated with OS (HR 1.3, 95%CI 0.8-2.2). In Uganda, cervical cancer is often incompletely treated and survival remains poor. HIV infection was not associated with cervical cancer stage at diagnosis, but may be weakly associated with shorter survival.


Cervical cancer; Global health; HIV/AIDS; Sub-Saharan Africa; Survival; Uganda

Conflict of interest statement

RU has received royalties from UpToDate, Inc. The authors otherwise have no conflicts of interest to report

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