Background: 

In Botswana, nearly two-thirds of cervical cancer patients are HIV-positive. This study examined the relationship between CD4 count and chemoradiation therapy outcomes among cervical cancer patients with HIV.

Setting: 

A prospective cohort study of 231 HIV-positive women with locally invasive cervical cancer was conducted in Gaborone, Botswana from January 2015 to February 2018.

Methods: 

Primary outcome was survival, defined as time from scheduled end of chemoradiation therapy to death or last contact with patient. Nadir CD4 count was defined as lowest CD4 available before cancer diagnosis. Delta CD4 count was defined as improvement from nadir CD4 to CD4 at cancer diagnosis. Hazard ratio (HR) analyses were adjusted for presenting variables (age, baseline hemoglobin, cancer stage, and performance status) and treatment variables (chemotherapy cycles and radiation dose).

Results: 

Two hundred thirty-one patients were included in nadir CD4 analysis; 139 were included in delta CD4 analysis. Higher delta CD4 was significantly associated with reduced mortality after adjusting for presenting and treatment variables (CD4 100–249: HR 0.45, 95% CI: 0.21 to 0.95; CD4 ≥250: HR 0.45, 95% CI: 0.20 to 1.02). Higher nadir CD4 showed a trend toward reduced mortality after adjusting for presenting and treatment variables (HR 0.94, 95% CI: 0.84 to 1.06).

Conclusions: 

Higher delta CD4 (greater improvement from nadir CD4 to CD4 at cervical cancer diagnosis) is significantly associated with lower mortality. Although not statistically significant, data suggest that higher nadir CD4 may reduce mortality. These results reinforce the importance of early HIV diagnosis and antiretroviral therapy initiation, as their effects influence cervical cancer outcomes years later.

中文翻译：

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HIV宫颈癌患者CD4计数与化学放射治疗结果之间的关联

背景： 

在博茨瓦纳，将近三分之二的宫颈癌患者是HIV阳性。本研究检验了HIV宫颈癌患者CD4计数与化学放射治疗结果的关系。

设置： 

2015年1月至2018年2月，在博茨瓦纳的哈博罗内进行了231名患有局部浸润性宫颈癌的HIV阳性女性的前瞻性队列研究。

方法： 

主要结局为生存期，定义为从放化疗结束到死亡或最后与患者接触的时间。最低点CD4计数定义为在癌症诊断之前可用的最低CD4。Delta CD4计数定义为癌症诊断时从最低CD4改善到CD4。调整危害比（HR）分析，以显示变量（年龄，基线血红蛋白，癌症分期和生产状况）和治疗变量（化学疗法周期和放射剂量）。

结果： 

最低CD4分析中包括231例患者。139包括在增量CD4分析。更高增量CD4被显著调整用于呈现和处理的变量（后具有降低的死亡率相关CD4 ;：：HR 0.45，95％CI 0.21至0.95 100-249 CD4：HR 0.45，95％CI：0.20〜1.02≥250）。调整了呈递和治疗变量后，最高天体CD4表现出死亡率降低的趋势（HR 0.94，95％CI：0.84至1.06）。

结论： 

较高的CD4增量（在诊断宫颈癌时从最低的CD4改善为CD4）与较低的死亡率显着相关。尽管无统计学意义，但数据表明较高的最低CD4可能会降低死亡率。这些结果增强了早期HIV诊断和抗逆转录病毒疗法启动的重要性，因为它们的影响会在数年后影响子宫颈癌的预后。