Breast Cancer and HIV in the Era of Highly Active Antiretroviral Therapy: Two Case Reports and Review of the Literature

Abstract

The incidence of human immunodeficiency virus (HIV) infection is rising in US women; however its impact on breast cancer incidence, stage at presentation, response and treatment toxicity remains unknown. To address the impact of HIV infection and use of highly active antiretroviral therapy (HAART) on the natural history of breast cancer we present two cases of breast cancer in HIV-infected women and also review the literature. A literature search was done on Medline using the key words HIV/AIDS, breast cancer, and HAART therapy, restricted to English language. There were mostly case reports and one large series of 20 cases reported by Hurley et al. Data concerning the impact of HIV infection and HAART therapy regarding pathogenesis, stage at presentation, tumor type, response, and toxicity associated with treatment were reviewed. The literature review shows that the breast cancer incidence is either same or less in HIV-infected patients compared to the general population. However, the patients with HIV infection present with more advanced stage and aggressive disease, and they also have poor chemotherapy tolerance. The impact of HAART on breast cancer incidence in HIV-infected patients is still unclear.

Breast cancer characteristics and HIV among 1,092 women in Soweto, South Africa

“…We believe that the safest approach is to initiate chemotherapy after initiating ART. Modifications of standard regimens for patients with the two diagnoses have been proposed, but evidence for the safety or efficacy of such modifications, compared to alternatives, is lacking [24, 25]. Clinical studies are needed to address this issue, but they are unlikely to be undertaken in the near future.…”

Breast Cancer in the Setting of HIV

“…This is not particularly surprising however, as only 48 cases of breast cancer have been noted in HIV-positive people to date [11]. This number may be contested due to lack of case presentation (e.g., poorer socioeconomic groups/people of the third world less likely to seek medical care) or that women with HIV may have a reduced lifespan (and therefore are less likely to reach an age at which breast cancer may occur) [12].…”

“…The majority of studies have found no difference in the incidence of breast cancer in HIV-positive women and the HIV-negative population [11]. An American study by Frisch et al found the relative risk of developing breast cancer after HIV infection was 1.1, that is, HIV infection had little impact on breast cancer incidence [7], and other studies have supported this [9, 14].…”

Specific nutritional infections early in life as risk factors for human colon and breast cancers several decades later

“…Immunosuppression, in particular when induced by human immunodeficiency virus (HIV) infections, provided an answer: prior to the introduction of the highly active anti‐retroviral therapy (HAART) follow‐up studies claimed a reduced risk for breast cancer in HIV‐infected women (reviewed in Refs. 96,97). After successful HIV‐therapy, the risk for these cancers, as well as for prostate cancer remained comparable to the non‐HIV‐infected population.…”