{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:21:10Z","timestamp":1792614070212,"version":"4.5.0"},"reference-count":39,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T00:00:00Z","timestamp":1603497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Head and neck cancer (HNC) is the fifth most common malignancy in sub\u2010Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)\u2010infection. HIV patients have higher rates of HNC, yet the effect of HIV\u2010infection on oncologic outcomes and treatment toxicity is poorly characterized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective observational cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>HNC patients attending a government\u2010funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV\u2010status. Overall survival (OS) was evaluated via Kaplan\u2013Meier.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study enrolled 149 patients with a median follow\u2010up of 23\u2009months. Patients presented with advanced disease (60% with T4\u2010primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5\u2009months). Median OS was 36.2\u2009months. Anemia was associated with worse survival (HR 2.74, <jats:italic>P<\/jats:italic> = .001). Grade\u2009\u2265\u20093 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, <jats:italic>P<\/jats:italic> = .03) and BMI\u2009&lt;\u200920\u2009kg\/m<jats:sup>2<\/jats:sup> (OR 6.04, <jats:italic>P<\/jats:italic> = .012). Forty percent of patients (n = 59) were HIV\u2010infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with \u2264400 copies\/mL), and had immunocompetent CD4 counts (median 400 cells\/mm<jats:sup>3<\/jats:sup>). HIV\u2010status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite access to government\u2010funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV\u2010status does not adversely affect outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2c <jats:italic>Laryngoscope<\/jats:italic>, 131:E1558\u2013E1566, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29206","type":"journal-article","created":{"date-parts":[[2020,10,24]],"date-time":"2020-10-24T12:21:07Z","timestamp":1603542067000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Management of Head and Neck Cancers With or Without Comorbid <scp>HIV<\/scp> Infection in Botswana"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8880-5062","authenticated-orcid":false,"given":"Gwendolyn J.","family":"McGinnis","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology MD Anderson Cancer Center  Houston Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S.","family":"Ning","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology MD Anderson Cancer Center  Houston Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Memory","family":"Bvochora\u2010Nsingo","sequence":"additional","affiliation":[{"name":"Department of Oncology Gaborone Private Hospital  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebathu","family":"Chiyapo","sequence":"additional","affiliation":[{"name":"Department of Oncology Gaborone Private Hospital  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Balang","sequence":"additional","affiliation":[{"name":"Department of Oncology Gaborone Private Hospital  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tlotlo","family":"Ralefala","sequence":"additional","affiliation":[{"name":"School of Medicine University of Botswana  Gaborone Botswana"},{"name":"Princess Marina Hospital  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola M.","family":"Zetola","sequence":"additional","affiliation":[{"name":"School of Medicine University of Botswana  Gaborone Botswana"},{"name":"Department of Radiation Oncology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Grover","sequence":"additional","affiliation":[{"name":"School of Medicine University of Botswana  Gaborone Botswana"},{"name":"Princess Marina Hospital  Gaborone Botswana"},{"name":"Department of Radiation Oncology, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."},{"name":"Botswana University of Pennsylvania Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_6_3_1","unstructured":"FerlayJ ErvikM LamF et al.Cancer today. 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