title: Outcomes of cervical cancer among HIV-infected and HIV-uninfected women treated at the Brazilian National Institute of Cancer.
abstract: We assessed mortality, treatment response, and relapse among HIV-infected and HIV-uninfected women with cervical cancer in Rio de Janeiro, Brazil.
  
  
  
  Cohort study of 87 HIV-infected and 336 HIV-uninfected women with cervical cancer.
  
  
  
  Patients at the Brazilian National Institute of Cancer (2001-2013) were matched on age, calendar year of diagnosis, clinical stage, and tumor histology. Staging and treatment with surgery, radiotherapy, and/or chemotherapy followed international guidelines. We used a Markov model to assess responses to initial therapy, and Cox models for mortality and relapse after complete response (CR).
  
  
  
  Among 234 deaths, most were from cancer (82% in HIV-infected vs. 93% in HIV-uninfected women); only 9% of HIV-infected women died from AIDS. HIV was not associated with mortality during initial follow-up but was associated more than 1-2 years after diagnosis [overall mortality: stage-adjusted hazard ratio 2.02, 95% confidence interval (CI) 1.27-3.22; cancer-specific mortality: 4.35, 1.86-10.2]. Among 222 patients treated with radiotherapy, HIV-infected had similar response rates to initial cancer therapy as HIV-uninfected women (hazard ratio 0.98, 95% CI 0.58-1.66). However, among women who were treated and had a CR, HIV was associated with elevated risk of subsequent relapse (hazard ratio 3.60, 95% CI 1.86-6.98, adjusted for clinical stage).
  
  
  
  Among women with cervical cancer, HIV infection was not associated with initial treatment response or early mortality, but relapse after attaining a CR and late mortality were increased in those with HIV. These results point to a role for an intact immune system in control of residual tumor burden among treated cervical cancer patients.
authors.affiliation: aPrograma de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil bDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA cSeção de Ginecologia Oncológica dPrograma de Carcinogênese Molecular ePrograma de Pesquisa Clínica, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Mariana P
authors.initials: MP
authors.lastname: Ferreira
authors.forename: Anna E
authors.initials: AE
authors.lastname: Coghill
authors.forename: Claudia B
authors.initials: CB
authors.lastname: Chaves
authors.forename: Anke
authors.initials: A
authors.lastname: Bergmann
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Thuler
authors.forename: Esmeralda A
authors.initials: EA
authors.lastname: Soares
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Soares
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*