title: HIV Status and Acute Hematologic Toxicity Among Patients With Cervix Cancer Undergoing Radical Chemoradiation.
abstract: BACKGROUND
  Women infected with the human immunodeficiency virus (HIV) have a higher risk of developing cervix carcinoma than do other women who are thought to be more vulnerable to acute toxicities during chemoradiation. We compared HIV-positive/HIV-negative patients with cervix carcinoma at a single institution with respect to cancer treatment toxicities.
  
  
  METHODS
  Among patients with stage Ib1-IIIb invasive cervical carcinoma who received radiation or chemoradiation with curative intent, we evaluated demographic and clinical characteristics of HIV-positive and HIV-negative patients. Treatment regimens were documented and toxicities scored as per Radiation Therapy Oncology Group guidelines. We developed logistic regression models for the associations of grade 3/4 toxicities with HIV status.
  
  
  RESULTS
  Complete data were available on 213 patients, including 36 (16.8%) who were HIV positive. More than 85% of both HIV-positive and HIV-negative patients received a minimum of 68-Gy equivalent dose in 2-Gy-fraction external beam and high-dose-rate brachytherapy. More HIV-positive than HIV-negative patients were prescribed radiation alone (38.9% vs 24.29%, P = 0.01), experienced at least 1 grade 3/4 toxicity (38.9% vs 26.6%), or developed grade 3/4 leucopenia (30.6% vs 10.2%, P = 0.003).In a multivariable model, patients who developed a grade 3/4 toxicity were 4 times as likely to have received chemotherapy (odds ratio, 4.41 [95% confidence interval, 1.76-11.1]; P = 0.023) and twice as likely to be HIV positive (odds ratio 2.16 [95% confidence interval, 0.98-4.8]; P = 0.05) as women who did not experience such toxicities.
  
  
  CONCLUSIONS
  HIV-positive patients with cervical carcinoma received adequate radiotherapy but were less likely than HIV-negative patients to complete chemotherapy. Few HIV-positive or HIV-negative patients who received radiotherapy without chemotherapy experienced grade 3/4 toxicity. However, among patients who received chemotherapy, those who were HIV positive were more likely than others to experience hematologic toxicity.
authors: *Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Stellenbosch, South Africa; †Herbert Irving Comprehensive Cancer Centre, Columbia University, New York, NY; ‡Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and §Division of Oncology, Columbia University College of Physicians and Surgeons, New York, NY.
authors: Hannah M
authors: HM
authors: Simonds
authors: Alfred I
authors: AI
authors: Neugut
authors: Judith S
authors: JS
authors: Jacobson
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy / Q000821:virology; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy / Q000821:virology; D016022:Case-Control Studies; D059248:Chemoradiotherapy / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006402:Hematologic Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D055815:Young Adult