Comparative Study of Chemotherapy Tolerance and Immune Function Changes in Gynecological Malignancy Patients with HIV Positive and Negative Status

Objective: To compare and analyze the chemotherapy tolerance and immune function changes between gynecological malignancy patients with HIV-positive and HIV-negative status, providing evidence-based guidance for individualized chemotherapy regimens tailored to different HIV infection statuses. Methods: Clinical data of 57 gynecological malignancy patients who received chemotherapy at the Department of Obstetrics and Gynecology, Nanning Fourth People’s Hospital from January 2022 to December 2025 were retrospectively collected. Based on HIV infection status, they were divided into an HIV-positive group (n = 44) and an HIV-negative group (n = 13). The baseline clinical characteristics, laboratory indicators (blood routine, immune function) before and after chemotherapy, and the occurrence of complications were compared between the two groups. Statistical analysis was performed using independent samples t-test, χ² test, or Fisher’s exact test. Results: There were no statistically significant differences in baseline characteristics such as age, disease type (cervical cancer proportion 90.9% vs 92.3%), clinical stage (stage I-II proportion 70.5% vs 69.2%), and chemotherapy regimen (paclitaxel plus cisplatin proportion 75.0% vs 76.9%) between the two groups (P > 0.05). After chemotherapy, the white blood cell count decreased from 7.02 ± 3.15 × 10⁹/L to 5.13 ± 2.76 × 10⁹/L in the HIV-positive group and from 7.35 ± 2.98 × 10⁹/L to 5.42 ± 2.51 × 10⁹/L in the HIV-negative group, with no significant difference in the magnitude of decrease between groups (P = 0.921). In the HIV-positive group, CD4+ T-lymphocyte count decreased from 482 ± 295 cells/μL to 395 ± 241 cells/μL (P < 0.05), while the HIV-negative group showed no significant changes in immune indicators. The incidence of grade III-IV neutropenia was 13.6% (6/44) in the HIV-positive group vs 7.7% (1/13) in the HIV-negative group (P = 0.682); the incidence of gastrointestinal reactions was 84.1% (37/44) vs 84.6% (11/13) (P = 0.967); and the incidence of infectious complications was 9.1% (4/44) vs 7.7% (1/13) (P = 0.885). Among the HIV-positive patients, 3 cases (6.8%) had a viral load ≥50 copies/mL. Of these, 2 developed mild gastrointestinal reactions and 1 had grade I neutropenia, with no severe infections or chemotherapy interruptions reported. Conclusion: With standard antiretroviral therapy, the chemotherapy tolerance of