Background: As life expectancy of HIV+ women increases, there is increasing need to understand gynecologic malignancies beyond cervical cancer. There are no recent reports on the care of HIV+ women with these cancers nor HIV-specific guidelines. Thus, here we describe gynecological malignancies in HIV+ women and evaluate care and adherence to general treatment guidelines.
Methods: Johns Hopkins and University of Maryland clinic records and billing codes were used to identify all gynecologic cancer cases from 2000-2015. Chart reviews were conducted to obtain demographic, HIV, and cancer-related information. Abstraction of cancer treatment modalities allowed determination of adherence to NCCN-guidelines for each cancer type. Descriptive statistics were calculated to describe the patient population, cancer characteristics, and provision of treatment.
Results: Over the 15 year period, 47 gynecologic malignancies were identified in HIV+ women. The median age at diagnosis was 45 (IQR: 36-51), 89% of women were black, 60% were smokers, and 32% reported alcohol use. A roughly equal percentage of cervical cancers were identified (49%) compared to all other types combined (11% endometrial; 13% ovarian; 28% vaginal/vulvar). Women with vaginal/vulvar cancers were similar in age and CD4 count to women with cervical cancer but women with endometrial and ovarian cancers tended to be older and have higher CD4 counts at diagnosis. Treatment according to NCCN-guidelines was similar across cancer types: 96% of the 23 cervical cases; 85% of the 13 vaginal/vulvar cases although two stage I patients received no treatment; 100% of the 5 endometrial cases (all stage I); and 5/6 ovarian cases although only 1/5 late stage (III/IV) cases received ideal treatment (chemotherapy+surgery).

Cancer TypeDistributionMedian Age (IQR)Median CD4 count (IQR)NCCN treatment
Cervical23 (49%)45 (33-47)224 (116-419)22 (96%)
Endometrial5 (11%)54 (44-68)578 (294-1195)5 (100%)
Ovarian6 (13%)50 (44-52)544 (309-779)5 (83%)
Vaginal/vulvar13 (28%)44 (38-50)298 (173-554)11 (85%)
[Characteristics of cancer cases and treatment]

Conclusions: Most HIV+ women were treated according to NCCN-guidelines. However, over a third of women with cervical/vaginal/vulvar cancer did not to receive radiation-sensitizing chemotherapy, and women with late stage ovarian cancer tended to receive less than ideal treatment. Data on outcomes following cancer treatment in HIV+ women as compared to the general population are being collected to inform the need for specialized management in this population.

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