Investigating the Determinants of Cervical Cancer Disease State Among Women Living with HIV at Cancer Disease Hospital in Zambia

Abstract Background: Cervical cancer is the most common malignancy among Zambian women, and HIV coinfection accelerates disease progression. However, in the contemporary era of widespread antiretroviral therapy, the determinants of cervical cancer disease state among women living with HIV at Zambia's primary oncology referral centre are not fully understood. This study aimed to investigate these determinants at the Cancer Disease Hospital in Lusaka. Methods: An analytical cross-sectional study was conducted using medical records of 198 WLHIV with histologically confirmed invasive cervical cancer. Data on demographics, HIV status (CD4 count, viral load), and cancer characteristics (FIGO stage) were abstracted. Descriptive statistics, bivariate analyses, and multivariable logistic regression were performed. Results: The prevalence of advanced stage (Stage III/IV) cervical cancer was 34.4% (68/198), while 54.5% presented with Stage IIB disease. Metastatic disease was only 7.1% (14/198). The peak age of diagnosis was 40-49 years (51.5%). Median CD4 count was 484 cells/uL, and 89.4% had suppressed viral loads. No significant association was found between HIV disease status and advanced-stage cancer (CD4 <200: AOR 1.42, 95% CI 0.68-2.96; detectable viral load: AOR 1.38, 95% CI 0.71-2.68). Younger WLHIV aged 30 to 39 years had the highest proportion of advanced-stage disease (38.5%), as did peri-urban residents (40.0%) compared to Lusaka residents (30.0%). Conclusion: In the ART era, HIV disease status is no longer the dominant determinant of cervical cancer stage among WLHIV at CDH who develop invasive cancer, likely due to effective immune reconstitution. However, persistent Stage IIB presentation indicates inadequate screening coverage. Younger WLHIV and peri-urban residents are at highest risk of late-stage diagnosis. Keywords: Cervical Cancer; Uterine Cervical Neoplasms; Antiretroviral Therapy; HIV infections; FIGO Staging; Zambia