Clinicopathological Characteristics of Hiv Positive and Hiv Negative Patients With Figo Stages 1 to 11a Cervical Cancer at Kenyatta National Hospital: a Comparative Cross-sectional Study

Abstract

Background: Around 604,000 new cases of cancer of the cervix and 342,000 deaths from cervical cancer were reported worldwide in 2020 with human immunodeficiency virus (HIV) infections found to exacerbate its occurrence by 6.07 times. The double burden of being HIV positive and developing cancer of the cervix is a cause of concern worldwide, especially in Africa where 85% of these cases have been reported. In women living with HIV (WLH), cancer of the cervix develops among younger women, tends to be aggressive, responds poorly to treatment, and has a high rate of recurrence following treatment. In Kenya, there is limited data on cervical cancer prognosis among patients with and without HIV. Study design/setting: Comparative cross-sectional study at Kenyatta National Hospital (KNH) Study population: Early-stage (stage I-IIA) cervical cancer patients who were HIV positive and those who were HIV negative. Study objective: To compare clinicopathological characteristics of women living with HIV and HIV negative women seen at Kenyatta National Hospital (KNH) from 2011 to 2021 with FIGO stages I to IIA cervical cancer. Methodology: A comparative retrospective cross-sectional study was conducted in 2022. The hospital files of 114 cervical cancer patients living with HIV and 114 HIV-negative cervical cancer patients were retrieved from the records department. Demographic data such as age, gender, and education level; reproductive health data such as cervical cancer screening and parity; clinical data such as symptomology; and histopathology data such as cervical cancer stage, grade, histologic types, lymphovascular space invasion, and lymph node involvement were abstracted, uploaded into Statistical Package for Social Scientists (SPSS, version 25) spreadsheet and compared using Chi-square test. Logistic regression was used to adjust for demographic and reproductive factors at a 95% Confidence Interval (CI). A probability value (p-Value) of less than 0.05 was statistically significant. Odds ratios and adjusted odds ratios were interpreted as measures of effect size. Results: The median age of cervical cancer patients who were HIV positive was significantly lower (42 years [IQR=38-49]) compared to HIV negative cervical cancer patients (47 years [40-56], p=0.011). In addition, HIV positive patients were more likely to have undergone cervical cancer screening (p=0.012), and more likely to have a higher FIGO stage (stage IIA2) compared to HIV negative women after adjusting for their age, marital status, cervical cancer screening, and age at diagnosis (AOR=7.39, (95% CI =1.53-35.7), p=0.013). Other demographic and reproductive characteristics, nodular characteristics, and lymphovascular space invasion were comparable between the groups. Conclusions: HIV patients with cervical cancer were 5 years younger than HIV negative patients. There was no statistically significant difference in the histological type, degree of tumour differentiation, and lymph node involvement of cervical cancer between the HIV negative and positive women.