Characterizing trimodal therapy outcomes by HIV status in early-stage cervical cancer: a retrospective cohort study from a Kenyan tertiary center

Adjuvant concurrent chemoradiotherapy following radical hysterectomy is the cornerstone of curative-intent treatment for early-stage cervical cancer. However, among people living with Human Immunodeficiency Virus (PLWHIV) and cervical cancer, the interplay of treatment toxicity, immunosuppression and systemic health barriers presents a compounded clinical challenge. Evidence on how HIV infection influences baseline clinical patterns and prognosis following standard multimodal therapy remains poorly characterized. We conducted a descriptive retrospective cohort review of women with FIGO 2018 stage IA–IIA cervical cancer who had completed curative-intent trimodal therapy (adjuvant pelvic external-beam radiotherapy (45–50.4 Gy), weekly cisplatin (40 mg/m²), and brachytherapy following radical hysterectomy (type II/III) with pelvic lymphadenectomy) between 2014 and 2023, at a tertiary referral hospital in Kenya. The baseline clinicopathological characteristics, treatment-related toxicities, 3-year disease-free survival (DFS), and 5-year overall survival (OS) were described. Results were stratified by HIV status. Survival analysis was conducted using Kaplan-Meier estimates and log-rank tests. Over the 10-year study period, 275 patients with cervical cancer underwent radical hysterectomy with bilateral pelvic lymphadenectomy. Of 62 patients meeting criteria for adjuvant therapy (17 PLWHIV, 45 HIV-negative), 38 (61.3%) completed trimodal therapy. This corresponded to a completion rate of 76.5% (13/17) among PLWHIV versus 55.6% (25/45) among HIV-negative patients. Baseline clinicopathological profiles, including age, performance status, and histology (squamous cell carcinoma: 100% versus 88.0%) did not differ substantially between groups. Positive lymph nodes were the most common high-risk feature (53.8% versus 40.0%), and lymphovascular space invasion (LVSI) was the predominant intermediate-risk feature (69.2% versus 40.0%). Median time from surgery to adjuvant therapy initiation was 77.5 days (IQR 42–210). Lymphedema (21.1%) and bladder dysfunction (18.4%) were the frequently reported any-grade chronic toxicities. overall. Myelosuppression occurred in 23.1% versus 4.0%. The 3-year DFS was 53.8% among PLWHIV and 77.6% among HIV-negative patients (log-rank p = 0.14); median OS was 14.5 months versus 21.1 months (log-rank p = 0.12). Five-year survival estimates were not attainable for PLWHIV due to early recurrence and mortality. Despite comparable baseline characteristics, PLWHIV showed a nonsignificant trend toward greater treatment-related toxicity and reduced survival following trimodal therapy for early-stage cervical cancer. These findings underscore the importance of regional strengthening of HIV-oncology integrated services and generating, prospective research on optimum management strategies for this vulnerable cohort. While concurrent chemoradiotherapy following radical hysterectomy is standard in management of early-stage cervical cancer with intermediate/high-risk features, our findings highlight that treatment completion rates are suboptimal. Moreover, the median time from surgery to adjuvant therapy initiation exceeds the recommended 6-week period. PLWHIV experienced numerically higher treatment related morbidity (especially myelosuppression), and reduced 3-year DFS compared to their HIV-negative counterparts. There is need for heightened vigilance and proactive management of myelosuppression among PLWHIV undergoing trimodal therapy. At systems level, survival gains may require addressing systemic barriers, specifically reducing delays in adjuvant therapy. Further research is required to explore mechanisms driving outcome disparities and to test integrated supportive care interventions in order to achieve optimum management for this special population.