# PD-L1 expression in squamous cervical carcinomas of Mozambican women living with or without HIV

## TL;DR

This study examines PD-L1 expression in cervical cancer patients in Mozambique, including those living with HIV, to assess potential for immunotherapy.

## Contribution

The study provides insights into PD-L1 expression in HIV-positive cervical cancer patients, a group often excluded from clinical trials.

## Key findings

- PD-L1 was positive in 20.1% of cases using TPS and 26.3% using CPS.
- HIV status did not significantly affect PD-L1 expression levels.
- CD8 expression influenced only CPS status.

## Abstract

Programmed death-ligand 1 (PD-L1) is overexpressed in squamous cervical cancer (SCC) and can be used for targeted immunotherapy. The highest mortality rates of SCC are reported in sub-Saharan Africa, where Human immunodeficiency virus (HIV) prevalence is high. In Mozambique most SCC patients present at advanced stages. Thus, there is a need to introduce new treatment options. However, immunocompromised patients were frequently excluded in previous clinical trials. Our aim was to determine if PD-L1 expression in SCC is as prevalent among women living with HIV (WLWH) as among other patients. 575 SCC from Maputo Central Hospital were included. HIV status was available in 266 (46%) cases PD-L1 expression was scored through tumour proportion score (TPS) and combined positive score (CPS). PD-L1 was positive in 20.1% of the cases (n = 110), TPS (score ≥ 25%) and in 26.3% (n = 144), CPS (score ≥ 1). Stratifying according to the HIV status, WLWH were TPS positive in 16.7%, compared to 20.9%, p = 0.43, and concerning CPS 21.1% versus 28.7%, p = 0.19, respectively. PD-L1 status was not influenced by stage, Ki-67 or p16, CD8 expression influenced only CPS status. Our data indicates that the documented effect of PD-L1 therapy on SCC should be confirmed in randomized clinical trials in an HIV endemic milieu.