Survival disparities in cervical cancer patients with and without HIV at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH).

Abstract

e17539 Background: Cervical cancer is the leading cause of cancer-related deaths among Kenyan women, with 3,211 deaths reported in 2023. Women with HIV have a 4- to 5-fold higher risk of cervical cancer due to compromised immunity. However, studies on survival outcomes among cervical cancer patients by HIV status remain limited in Kenya. This study examines survival outcomes and associated factors among cervical cancer patients at JOOTRH, comparing HIV-positive and HIV-negative individuals. Methods: This retrospective study analyzed paper-based records of women diagnosed with cervical cancer at JOOTRH (January 2013–December 2024). Survival, defined as time from diagnosis to death or last follow-up, was estimated using Kaplan-Meier analysis, while Cox regression assessed risk disparities between HIV-positive and HIV-negative women. Results: Among 763 women diagnosed, 87% knew their HIV status, with 62% (n=413) HIV positive; 98% (n=403) were on ART. HIV-positive patients had a lower median age (45 years) than HIV-negative and unknown-status patients, with the most common age group being 46–64 years. Cancer staging data was missing for 71.1% (n=470). Among staged cases, 20% (n=50) were HIV-negative and diagnosed at stage 3 or 4. 62% (n=410) did not receive treatment, with chemotherapy alone being the most common modality (17%, n=126). The median time to treatment was 80 days (IQR: 29–211), with no significant differences across HIV status. The five-year survival probability among HIV-positive and unknown-status patients was 31% (CI: 12%–65%, p=0.005). HIV-positive patients had a shorter median survival (90 days, IQR: 33–280) and higher mortality (81%, n=336) than HIV-negative patients. HIV positivity increased the risk of death 1.2 times (HR 1.2, 95% CI: 1.0–1.4, p=0.05), while lack of treatment increased risk 3.5 times (HR 3.5, 95% CI: 2.9–4.3, p<0.001). Conclusions: Approximately 87% of patients knew their HIV status, falling short of the UNAIDS 95-95-95 target. Cancer staging was missing in 71%, and 62% did not receive treatment. Survival was worse among HIV-positive and unknown-status patients, with a five-year survival probability of 31% and 81% mortality among HIV-positive women. HIV positivity and lack of treatment increased the risk of death by 1.2 and 3.5 times, respectively. These findings underscore the need for universal opt-out HIV testing, timely cancer treatment, and integrated HIV-oncology care to improve survival outcomes.