BACKGROUND: Cervical cancer associated with human papillomavirus has thehighest cancer incidence and mortality for women in Botswana because of a highHIV prevalence and limited screening. This study investigates the significance ofHIV on the overall survival (OS) of patients with locally advanced cervical cancer byvarious treatment categories (curative chemoradiation, definitive radiation [RT]alone, or palliative RT alone).

METHODS: This study included patients diagnosed with cervical cancer between2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort.OS based on HIV status and completion of planned treatment regimen was esti-mated by the Kaplan–Meier method. Comparisons of 2‐year OS by HIV status wasperformed by the log‐rank test, univariate and multivariable Cox analyses adjustingfor cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobinlevels.

RESULTS: Of 1131 patients diagnosed with stage IB‐IVB cervical cancer, 69.8%were women living with HIV (n = 789). For patients receiving curative chemo-radiation, HIV status was not significantly associated with OS in unadjusted(p = .987) and adjusted (p = .578) analyses. For RT only treatment and definitive(high‐dose) RT alone, HIV status was significantly associated with OS in unadjustedanalysis (HR = 1.77, p = .002; HR = 1.95, p = .014), but not in adjusted analysis(p = .227, p = .73). For patients receiving palliative (low‐dose) RT, HIV status wasnot associated with OS in unadjusted (p = .835) or adjusted analysis (p = .359).

CONCLUSIONS: In Botswana, a resource‐limited setting, HIV status had no sig-nificant effect on 2‐year OS in patients with cervical cancer with well‐managed HIV

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