Patients With HIV at Greater Risk of Neutropenia, Not Completing Chemoradtiotherapy

October 31, 2018

Among women with HIV, there is an increased risk of neutropenia during chemoradiotherapy treatment for cervical cancer and they are less likely to complete chemotherapy with cisplatin.

While the introduction of antiretroviral therapy (ART) has led to drops in incidence of certain cancers, including Kaposi sarcoma and non-Hodgkin lymphoma, among the HIV population, cervical cancer has remained one of the most common malignancies in women with the virus.

Now, a new study has indicated that among women with HIV, there is an increased risk of neutropenia during chemoradiotherapy treatment for cervical cancer and they are less likely to complete chemotherapy with cisplatin.

“HIV infection is associated with myelosuppression, and neutropenia occurs in up to 30% to 83% of the patients,” wrote the study researchers. Due to this increased risk, and subsequent risk of not completing cisplatin-based chemoradiotherapy treatment, these patients also have impacted overall survival.

The study followed 61 women, with or without HIV, recently diagnosed with cervical cancer from Centro Hospitalar Lisboa Norte in Lisbon, Portugal, between January 2012 and December 2016.

Patients were given cisplatin 40mg/m2 intravenously over 60 minutes weekly for 6 doses, and 1000 mm of 0.9% sodium chloride were administered with 2 g of magnesium sulfate and 20 mEq/L of potassium chloride over 90 minutes both before and after cisplatin. Radiation was delivered as whole pelvic radiotherapy followed by a boost with brachytherapy or with external beam radiotherapy.

Among the 61 women, 6 were HIV positive and 55 were HIV negative. Clinical stage at diagnosis and the mean age were similar between the 2 groups. Four of the HIV patients were receiving ART during treatment.

Mean T CD4+ count before chemoradiotherapy was 567.5 cells/mm3 and was significantly lower among women with HIV who were not receiving ART compared with those receiving ART. Baseline neutrophil count was 4255/μL among women with HIV not receiving ART and was 4555/μL among women with HIV receiving ART. The baseline neutrophil count was not significantly different among women with HIV and women without HIV.

Throughout the 6 cycles of treatment, neutrophil counts decreased in both cohorts, with neutropenia occurring in 66.7% of women with HIV and in 34.4% of women without HIV. In the multivariate analysis, the women with HIV had a significantly increased risk of neutropenia (adjusted odds ratio 7.3, 95% CI, 1.02-52.3; P = .05.).

While 81.8% of women without HIV received 5 or more cycles of cisplatin, 66.7% of women with HIV received 5 or more cycles. Women with HIV also had more chemotherapy cycle delays and were more likely to use granulocyte colony-stimulating factors during chemoradiotherapy. However, there was no significant impact on the delivery of radiation.

“Our results are in line with those obtained by previous authors, who concluded that more HIV positive patients experienced serious toxicity, including leukopenia, although in that cohort, HIV positive patients had a 30.6% incidence of grade 3 to 4 leukopenia when compared with 10.2% of HIV negative patients; in our study, the incidence was lower (16.7% vs 3.6%),” noted the researchers.

Reference:

Vendrell I, Ferreria A, Abrunhosa-Branquinho A, et al. Chemoradiotherapy completion and neutropenia risk in HIV patients with cervical cancer [published July 2018]. Medicine. doi: 10.1097/MD.0000000000011592.