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 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 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