HIV-positive gynecological cancer patients who were hospitalized and received chemotherapy in the Obstetrics and Gynecology Ward of Nanning Fourth People’s Hospital from January 1, 2020 to December 31, 2024 were selected. Inclusion criteria: (1) Pathologically confirmed gynecological malignant tumor; (2) Positive HIV-1 antibody test and receiving ART; (3) Completed at least one cycle of systemic chemotherapy during hospitalization; (4) Complete clinical medical records. Exclusion criteria: (1) Complicated with other primary malignant tumors of other systems; (2) Pregnant or lactating women; (3) Unable to cooperate with treatment and evaluation due to severe mental illness or cognitive impairment; (4) Incomplete clinical data or loss to follow-up. Finally, a total of 44 patients were included.

A retrospective case analysis was adopted. The following information was collected through the hospital electronic medical record system, HIV/AIDS special disease management system, and nursing records: (1) Demographic data: age, marital status, occupation, etc. (2) HIV infection-related information: infection route, diagnosis time, ART regimen and duration, latest CD4⁺T cell count and viral load (within 3 months before chemotherapy). (3) Tumor-related information: tumor type, stage (FIGO stage), pathological type, chemotherapy regimen, number of cycles. (4) Clinical indicators during treatment: blood routine, liver and kidney function, electrolytes before and after each chemotherapy; chemotherapy adverse reactions (graded according to CTCAE 5.0 standard); type, time, and treatment of opportunistic infections. (5) Nursing management measures: symptom assessment and intervention records, infection prevention measures, medication guidance, nutritional support, psychological care, and health education content. (6) Treatment outcomes: chemotherapy completion status, short-term efficacy evaluation (according to RECIST 1.1 standard), survival status.

SPSS 30.0 software was used for data analysis. Measurement data conforming to normal distribution were expressed as x ± s, and those not conforming to normal distribution were expressed as median (M) and interquartile range (IQR); counting data were expressed as number of cases (n) and percentage (%). Inter-group comparison was performed using t-test, Mann-Whitney U test, or χ² test according to data type. Multivariate Logistic regression analysis was used to identify independent factors affecting chemotherapy completion rate and efficacy. P < 0.05 was considered statistically significant.

The clinical criteria for infection prevention were clarified: Referring to the “Guidelines for the Diagnosis and Treatment of AIDS (2021 Edition)” [5] and related infection prevention and control studies [6], when the patient’s CD4⁺T cell count before chemotherapy was <200 cells/µL, prophylaxis for Pneumocystis jirovecii pneumonia (PCP) was initiated, and sulfamethoxazole-trimethoprim tablets were administered orally (1 tablet each time, once a day) from 1 week before chemotherapy to 2 weeks after the end of chemotherapy; when the patient developed fever (body temperature ≥38.5˚C for more than 24 hours) or neutropenia (neutrophil count <1.0 × 10⁹/L), broad-spectrum antibiotics were promptly initiated for anti-infection treatment, and etiological examinations (including blood culture, sputum culture, fungal culture, etc.) were completed; for high-risk groups of oral candidiasis (CD4⁺T cell count <300 cells/µL), routine oral mucosa assessment was performed twice a week, and fluconazole gargle was promptly administered if abnormalities were found.

All 44 patients were female, aged 24 - 70 years with an average of (48.8 ± 9.7) years, of which 45.5% (20/44) were aged 31 - 50 years. Marital status: 65.9% (29/44) were married or had fixed partners. HIV infection route was mainly heterosexual transmission (accounting for more than 90% according to case records). All patients received ART, and the median treatment duration was 3.8 years (IQR: 1.9 - 7.2 years) according to case tracing. The median CD4⁺T cell count before chemotherapy was estimated to be 368 cells/µL (IQR: 245-502) according to clinical records, and 75.0% (33/44) of patients had a viral load below the lower limit of detection (<50 copies/mL). See Table 1 for details.

Table 1. Basic Characteristics of Patients. (n = 44)

Distribution of tumor types: 28 cases (63.6%) of cervical cancer, of which squamous cell carcinoma accounted for 85.7% (24/28); 8 cases (18.2%) of ovarian cancer; 5 cases (11.4%) of endometrial cancer; 3 cases (6.8%) of others. FIGO stage: 17 cases (38.6%) were stage I - II, and 27 cases (61.4%) were stage III - IV. Chemotherapy regimens: platinum-based combined with paclitaxel was the most commonly used regimen (65.9%, 29/44), followed by cisplatin combined with other drugs (such as 5-FU, bleomycin, etc.) for cervical cancer (22.7%, 10/44). The median number of chemotherapy cycles received by patients was 4 (range: 2-7). See Table 2for details.

Table 2. Tumor Disease Characteristics and Treatment Status. (n=44)

*Note: The percentage in parentheses is the proportion of this tumor type (cervical cancer).

During chemotherapy, the CD4⁺T cell count showed a fluctuating downward trend. The average CD4⁺T cell count before chemotherapy was 368 cells/µL, 319 cells/µL in the first cycle, 276 cells/µL in the second cycle, reaching the lowest point of 232 cells/µL after the third cycle of chemotherapy, and gradually recovering to an average of 298 cells/µL after the end of chemotherapy. See Figure 1 for details. A total of 8 patients (18.2%) developed opportunistic infections, including: oral candidiasis: 3 cases (37.5%); Pneumocystis jirovecii pneumonia (PCP): 2 cases (25.0%); herpes zoster: 2 cases (25.0%); Mycobacterium tuberculosis infection: 1 case (12.5%). Most opportunistic infections occurred in patients with CD4⁺T cell count < 200 cells/µL (6/8, 75.0%). See Figure 2for details.

Figure 1. Trend of CD4⁺T Cell Count During Chemotherapy. (Median)

Figure 2. Distribution of Types of Opportunistic Infections. (n = 8)

A total of 203 chemotherapy cycles were completed in 44 patients. The occurrence of adverse reactions was as follows (counted by the highest grade): myelosuppression: 25 cases (56.8%), including 10 cases (22.7%) of grade III - IV neutropenia; gastrointestinal reactions: 21 cases (47.7%), with nausea and vomiting being the most common, 5 cases (11.4%) of grade III and above; abnormal liver and kidney function: 10 cases (22.7%), mostly grade I - II elevation of transaminase or creatinine; neurotoxicity: 8 cases (18.2%), mainly paclitaxel chemotherapy-related peripheral neuropathy; allergic reactions: 3 cases (6.8%), mainly paclitaxel infusion-related. SeeTable 3and Figure 3for details.

Table 3. Occurrence of Main Chemotherapy Adverse Reactions. (n = 44, counted by number of patients)

*Note: The percentage of grade III - IV cases is the proportion of all 44 patients.

Figure 3. Incidence of Main Chemotherapy Adverse Reactions.

All patients received systematic specialized nursing management, with core measures including:

1) Refined symptom management: Referring to oncology nursing standards [7], a dynamic assessment form for chemotherapy adverse reactions was established to record the patient’s body temperature, pain score (NRS score), nausea and vomiting severity (graded according to CTCAE 5.0), and defecation status at 10:00 AM and 4:00 PM daily; for patients with myelosuppression, blood routine was monitored twice a day when the neutrophil count was <2.0 × 10⁹/L, granulocyte colony-stimulating factor (G-CSF) was administered subcutaneously as prescribed by the doctor, and patients were guided to do a good job in personal protection to avoid cross-infection; for patients with gastrointestinal reactions, antiemetic drugs (ondansetron + dexamethasone) were combined 30 minutes before chemotherapy, and gastric mucosal protectants were continuously administered within 48 hours after chemotherapy. Meanwhile, an individualized dietary guidance plan was formulated (such as light and easy-to-digest food, small and frequent meals, avoiding spicy and irritating food).

2) Strengthened infection prevention and control: According to relevant infectious disease standards [8] and infection prevention studies [6], strictly implement sterile operation standards, use disposable sterile consumables for venous puncture, and disinfect the puncture site twice a day; keep the ward environment clean, ventilate twice a day for 30 minutes each time, wipe the surface of objects with chlorine-containing disinfectant (concentration 500 mg/L), and conduct thorough disinfection once a week; guide patients to do a good job in oral, skin, and perineal care, oral care twice a day (morning and before bedtime) with a soft-bristled toothbrush to avoid oral mucosal damage, perineal care once a day to keep the local area dry and clean; strictly limit the number of visitors, no more than 2 visitors each time, and visitors must wear masks and hats and do a good job in hand hygiene.

3) Collaborative management of ART and chemotherapy: Combining HIV infection diagnosis and treatment guidelines [5] and drug interaction studies [9], a checklist for drug interaction assessment was established. Before chemotherapy, pharmacists and nurses jointly checked whether there was an interaction between the ART regimen and chemotherapeutic drugs, focusing on drugs with the same metabolic pathway (such as drugs metabolized by CYP3A4), and timely adjusted the drug dosage or administration time; a medication reminder form was formulated to remind patients to take ART drugs on time at 8:00 AM and 8:00 PM daily to avoid missing or taking wrong drugs. If adverse drug reactions (such as dizziness, nausea, etc.) occurred during chemotherapy, they were recorded in a timely manner and reported to the doctor to evaluate whether the treatment plan needed to be adjusted; liver and kidney function and electrolytes of patients were monitored once a week to detect drug-related damage in a timely manner.

4) Multidisciplinary Team (MDT) collaboration: Referring to the oncology MDT diagnosis and treatment model [10], an MDT team composed of obstetricians and gynecologists, infectious disease specialists, pharmacists, dietitians, psychologists, and specialized nurses was established to hold a case discussion meeting once a week to comprehensively evaluate the patient’s tumor treatment, HIV infection management, nutritional status, and psychological state, and formulate an individualized treatment and nursing plan; for complex cases (such as those with severe opportunistic infections and severe chemotherapy adverse reactions), an emergency MDT consultation was organized in a timely manner to adjust the treatment strategy.

5) Psychosocial support and health education: Based on oncology nursing standards [7] and HIV patient care studies [11], the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to assess the patient’s psychological state on admission, in the middle of chemotherapy, and before discharge. For patients with SAS/SDS scores ≥50, one-on-one psychological counseling was provided by psychologists twice a week for 30 minutes each time; a health education manual was established, including knowledge related to HIV infection, precautions for chemotherapy, methods to cope with adverse reactions, key points of nutritional support, and follow-up requirements, which was distributed to patients and their families on admission and explained one-on-one by nurses. A health lecture was organized once a week, inviting doctors and pharmacists to answer questions; a post-discharge follow-up mechanism was established to conduct follow-up by phone, WeChat, etc., once a week for 3 months to understand the patient’s recovery status, answer the patient’s questions in a timely manner, and urge the patient to return to the hospital for re-examination on time.

The coverage rate of each measure reached 100%.

Chemotherapy completion rate: 40 patients (90.9%) completed the planned chemotherapy cycles. 4 patients (9.1%) discontinued, mainly due to severe myelosuppression with infection (2 cases), disease progression (1 case), and intolerable adverse reactions (1 case) (see Figure 4).

Short-term efficacy: Among 41 evaluable patients, 6 cases (14.6%) achieved complete response (CR), 26 cases (63.4%) achieved partial response (PR), 7 cases (17.1%) had stable disease (SD), and 2 cases (4.9%) had progressive disease (PD). The total effective rate (CR + PR) was 78.0% (32/41) (see Figure 5).

Multivariate analysis showed that CD4⁺T cell count ≥350 cells/µL before chemotherapy (OR = 2.38, 95% CI: 1.25 - 4.53) was an independent protective factor for effective treatment. Due to the circularity between “completion of planned chemotherapy cycles” and treatment efficacy (non-completion of chemotherapy is often caused by disease progression or death), this variable was excluded from the multivariate Logistic regression analysis, which is in line with the rigor requirements of statistical analysis. (see Table 4).

Figure 4. Composition of Reasons for Chemotherapy Discontinuation. (n = 4)

Figure 5. Results of Short-term Efficacy Evaluation. (n = 41)

Table 4. Revised Multivariate Logistic Regression Analysis of Factors Affecting Short-term Efficacy. (CR+PR)