Cervical Cancer Outcomes and Toxicity in HIV-Positive Women Treated With Radiation or Chemoradiation: A Systematic Review

Cervical cancer disproportionately affects HIV-positive women, especially in low- and middle-income countries (LMICs), with a sixfold increased risk due to immunosuppression and persistent HPV infection. This systematic review evaluates the clinical outcomes and toxicities associated with radiotherapy or chemoradiation in HIV-positive compared to HIV-negative women with cervical cancer. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search on August 15, 2023 and an update on June 20, 2025, of Ovid Medline, EMBASE, and ClinicalTrials.gov from database inception to June 2025, as well as a manual review of citations. This process identified 18 cohort studies (11 prospective and seven retrospective), including 2,790 HIV-positive and 4,064 HIV-negative patients treated for cervical cancer with radiation-based treatments. The majority of studies (15 out of 18) were conducted in sub-Saharan Africa. The findings indicated that HIV-positive patients had a 33% lower overall survival (OS) compared to HIV-negative patients (1.33 (95% confidence interval (CI) 1.08-1.63), p = 0.0080). Women living with HIV had an increased risk of mortality, exhibiting a relative risk of 1.27 (95% CI 1.13-1.43, p = 0.0080). They also showed a trend toward lower complete response rates, with a relative risk of 0.92 (95% CI: 0.79-1.06, p = 0.1595). Treatment toxicity was reported in 10 studies, but the grading scales and toxicity reporting differed across studies. Some studies reported differences in toxicities by HIV status, while others found no difference. However, data regarding the impact of concurrent antiretroviral therapy (ART) were not available for assessment on their influence on treatment outcomes and toxicities. The findings underscore the significant research deficiencies in the management of cervical cancer among HIV-positive women undergoing radiation therapy. There is a pressing need for targeted research to elucidate clinical and toxicity outcomes, thereby refining management strategies for this specific patient cohort.