Clinicopathological Presentation and Treatment Outcomes Ofvulvar Cancer Patients Between Hiv Infected and Non-infected Patients

Abstract

Vulvar carcinoma is one of the rarest female genital malignancies with an incidence of 2.5 to 4.0 per 100,000 women, accounting for 3% to 5% of all female genital tract malignancies. It has traditionally been considered as a disease of the elderly, occurring at the age of 64 to 69 years. However, recently young age groups are getting vulvar cancer and this is associated with infection with human immunodeficiency virus (HIV). Broad Objective: To compare the clinicopathological presentation and treatment outcomes for cancer of the vulvar among HIV infected and non-infected patients managed at the Kenyatta National Hospital from 2012 to 2019. Methodology Study design:A retrospective cohort study Study site and setting:Kenyatta National Hospital Study population:All patients with a histological diagnosis of vulvar cancer and documented HIV status managed in KNH from 2012 to 2019, where the exposed group were patients with cancer of the vulvar and co-existing HIV infection while those in the non-exposed group were patients with cancer of the vulvar but negative for HIV infection. Sample size:138, (n=90 HIV positive and n=48 HIV negative) Data collection:Data for the records were collected using a specially designed data extraction tool, entered into excel sheet and analyzed using SPSS version 24 software. Data analysis:Categorical variables were compared between HIV positive and the HIV negative group using chi square test while comparison of means were tested using Student’s t test. Odds ratios were calculated to estimate relative risks associated with independent variables. Kaplan-Meier curve was plotted to illustrate the 2-year and 5-year survival rates of the patients following treatment in both HIV positive and the HIV negative groups. Statistical significance were interpreted at 5% level (p value less or equal to 0.05 was considered statistically significant). Results: The mean (SD) age for HIV positive patients was 42(10%) Compared to HIV negative patients which was 63(15%). On gross anatomical types, HIV positive patients had more fungating (39%) than ulcerative (51%) types, while HIV negative patients had more ulcerative (73%) than fungating (21%) types. Almost all HIV positive patients had squamous cell carcinoma (97%) unlike the HIV negative patients (81%). Lymphovascular space invasion occurred more in the HIV negative (31%) group than the HIV positive (16%). Majority of the HIV positive patients were of good immune status with Median (IQR) CD4 count of 419 (330 – 603) cells /mm3, and most were on ART. There was no difference in the cancer treatment offered to both groups of patients. There was no difference in 2 year survival between HIV positive and negative patients. At five years few (13%) of the HIV positive patients were still alive compare to 34% in the HIV negative group. Conclusion: Cancer of the vulvar at Kenyatta National Hospital is more common among HIV positive patients, who are younger than the HIV negative counterparts. Squamous cell carcinoma is the commonest histologic type in both groups though more in the HIV positive group. The HIV positive group are of good immunity and were all on ART. There was no difference in treatment modality between the two groups. There is no difference in the two year survival. At five years 13% and 34% are alive in the HIV positive and negative group respectively. There is a need to explore the reasons for poor survival in the HIV positive group.