In sub-Saharan Africa, insufficient radiotherapy appears to be hindering the survival prospects for women with cervical cancer, co-infected with HIV. Results from a pattern of care study carried out by the International Atomic Energy Agency in Uganda, Namibia, Tanzania and Zimbabwe show that inadequate radiotherapy proved more significant for patient survival during the first year than HIV status. Of the 147 women with biopsy-confirmed cervical cancer included in the study, 18.4% were found to be HIV-positive, yet this co-infection did not impact on survival rates. At 407 days, the median survival in HIV infected women was actually found to exceed that for HIV-negative patients. CD4 counts were temporarily depressed with radiotherapy but levels recovered after a few months and no detrimental effects were observed from concurrent administration to HIV-positive women.
Instead, what was found to be significant was the teletherapy dose patients received this was associated with significant inter-country variability. Lowest levels were recorded in Zimbabwe (mean 22.4 Gy) where a machine breakdown actually resulted in 10 registered patients not receiving any radiotherapy whatsoever during the period studied. The highest radiotherapy doses were used in Namibia and Uganda (mean 50 Gy). Overall analysis revealed that patients receiving higher radiotherapy doses had a significantly greater survival advantage. These results imply that resource limitations which restrict the appropriate use of radiotherapy may be responsible the early deaths of women with cervical cancer in certain African nations, regardless of HIV status.