title: Optimal management of cervical cancer in HIV-positive patients: a systematic review.
abstract: The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance.
authors.affiliation: College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Atara
authors.initials: A
authors.lastname: Ntekim
authors.affiliation: College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Oladapo
authors.initials: O
authors.lastname: Campbell
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006679:HIV Seropositivity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D010349:Patient Compliance; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*
keywords: Cervical cancer; HIV-positive; management