Real-world management of ovarian cancer in women living with HIV: treatment exposure, immune monitoring, and care barriers in a five-case series

Background With improved survival among people living with HIV (PLWH), non-AIDS-defining cancers have become increasingly prominent. Women living with HIV (WLWH) remain underrepresented in ovarian cancer trials, leaving limited evidence on the tolerability of standard therapies, including chemotherapy, anti-VEGF agents, and PARP inhibitors. These patients also face unique care barriers beyond biological uncertainties. Methods This retrospective review included five WLWH diagnosed with ovarian cancer (June 2022–March 2024). Three received anticancer treatment; one refused chemotherapy and was lost to follow-up; one had biopsy only. We collected data on demographics, HIV history, tumor characteristics, treatment exposure, adverse events (CTCAE v5.0), CD4 + /CD8 + counts, and HIV RNA, focusing safety and immune analyses on the three treated patients. Results Median age was 51 years; four had stage III–IV disease. No treatment-related deaths, persistent HIV rebound, or AIDS-defining events occurred. During first-line paclitaxel/carboplatin, one patient developed grade 3 neutropenia managed with G-CSF, but later developed significant thrombocytopenia on niraparib requiring dose reduction and hospitalization. Among two patients receiving bevacizumab, CD4 + patterns diverged: one showed a transient decline (387 to 259 cells/μL) with concurrent nedaplatin; another maintained stable counts (150 to 200 cells/μL). One patient had transient, self-limited HIV RNA elevation concurrent with disease progression, which resolved spontaneously. Conclusion This series provides real-world observations that platinum-based and targeted therapies may be delivered to selected WLWH with close monitoring. The heterogeneous CD4 + responses highlight the need for individualized immune surveillance rather than attributing changes to any single agent. Integrated oncologic-HIV care and attention to socioeconomic barriers remain critical for this underrepresented population.