The treatment of cervical cancer in the presence of HIV in Sub-Saharan Africa

Dr Ntokozo Ndlovu - University of Zimbabwe, Harare, Zimbabwe

Could you tell us about your presentation?

My talk was about the treatment of cervical cancer in the presence of HIV in Sub-Saharan Africa. This is a very important topic because cervical cancer, as we know, is very, very common in Sub-Saharan Africa and also the deaths of women from cancer in Sub-Saharan Africa are usually from cervical cancer. So these women not only just have cervical cancer alone but they also have HIV infection as well which means they have got two diagnoses that are very serious and both of them have to be attended to.

The main treatment for cervical cancer, this is invasive cervical cancer, is chemoradiation of which radiotherapy is required. We also know that in Africa the radiotherapy facilities are few and far between. So these women tend not to get the correct treatment that they have to get. This is not for all women with cervical cancer.

However, now when it comes to women who have got cervical cancer and HIV they become an even more vulnerable group and they are known to actually be younger, they are known not to respond sometimes to treatment as good as the women who don’t have HIV infection. Even in treatment decisions they are left out because sometimes clinicians modify their treatment and may not treat them in exactly the way that they are supposed to be treated for fear of side effects and things like that.

So the question is do we really know how we should be handling these women? Do we really know whether all these considerations are actually the correct ones? So what we really need is a strong evidence base in Africa to actually be able to manage these patients who have got both invasive cervical cancer and HIV. So there is more research that needs to be done and it can only be done in Africa because that’s where the problem lies. There are many studies that are done on cervical cancer globally but there is a disparity in terms of the number and the quality of research that goes on for cervical cancer, just as in any other cancer. So these women need to be seriously considered as a group that we should concentrate on so that we build an evidence base whereby we know that we are doing the right thing for them and meeting their needs and perhaps maybe giving them better outcomes of treatment.

Of note is that there are very good studies that are going on, some of them that can even be done in Africa which are being done elsewhere. For the first time in many decades they are producing results that may be able to actually help us to improve the lives of cervical cancer patients. But these are not being done in Africa, let alone they are not being done in women who have cervical cancer and HIV. In actual fact, HIV is an excluding criterion for those studies. So we really need to focus and make sure that in Sub-Saharan Africa we are taking care of these women so that we may be able to meet the global call by WHO of eliminating cervical cancer by 2030.

Is there anything else you would like to add?

To be able to meaningfully help these women and to be able to generate the evidence that is needed, there is a need for more deliberate funding for studies on these women so that we can make a difference. Also there is a deliberate need perhaps to even call upon multicentre clinical trials within Africa that will address these needs. There are many questions that need to be answered there – are these women more prone to side effects, as we think? What are the interactions between the HIV and the cancer? Are there any other ways that we can help these women without necessarily giving them radiotherapy? Because whilst we are calling for expansion of radiotherapy services, we know right now that there are many countries where radiotherapy is not available and yet cervical cancer is perhaps the first or the second most common cancer in women even in those countries. So right now as we speak, what can we do to help those women? Is there any other way perhaps that we can modify some of the treatment and be able to identify subsets of women who may benefit from treatment without radiotherapy? But ultimately, of course, the answer lies in the expansion of radiotherapy services and making sure that no patient who requires radiotherapy treatment goes without.