Impact of HIV infection on baseline characteristics and survival of women with breast cancer

Abstract

Background: As women living with HIV (WLWH) become older, their risk of developing breast cancer increases. Nonetheless, literature is conflicting regarding tumor stage, distribution of subtypes and overall survival among WLWH vs HIV-negative women with breast cancer. We assessed differences in clinicopathological characteristics and overall survival between these two groups. Methods: Systematic review and meta-analysis using MEDLINE, Scopus, ISI Web of Knowledge, LILACS, SciELO and conference abstracts up to 1/January/2020. Cross-sectional/cohort studies comparing baseline characteristics (stage and/or subtypes) and/or overall survival of WLWH vs HIVnegative women with breast cancer were included. We performed random-effects meta-analyses to estimate summary statistics and subgroup analyses according to region of the world. Results: 18 studies (4 from North America, 14 from Sub-Saharan Africa [SSA]) were included, with 3,174 WLWH and 2,394,598 HIV-negative women. WLWH from North America and SSA were more likely to present with stage III/IV disease compared to HIV-negative womenpooled odds ratio (pOR) 1.76 (95% confidence interval [CI]:1.58-1.95) and pOR 1.23 (95%CI:1.06-1.42), respectively. WLWH from SSA were also less likely to have estrogen receptor-positive/HER2-negative tumors (pOR 0.81; 95%CI:0.66-0.99). After adjustment, WLWH had worse overall survival compared to HIV-negative women, both in North America (pooled adjusted hazard ratio [aHR] 2.45; 95%CI:1.11-5.41) and SSA (aHR 1.43; 95%CI:1.06-1.92). Conclusions: Compared to HIV-negative women, WLWH are diagnosed with breast cancer at a more advanced stage and have a worse overall survival. These results should raise awareness regarding the detection and survival gap among WLWH with breast cancer and further studies are needed to decipher the reasons behind these disparities.

Impact of HIV infection on survival among women with stage I‐III breast cancer: Results from the South African breast cancer and HIV outcomes study

“…7,8 In a metaanalysis of BC outcomes in SSA, Brandão et al showed that WLWH was diagnosed with BC at a more advanced stage and had worse OS (HR: 1.43; 95% CI: 1.06-1.92) than HIV-uninfected women. 9 We have found no data on receipt of BC treatment and ART, viral loads or CD4 counts among WLWH with BC in SSA.…”

“…11-5.41) and SSA (HR: 1.43; 95% CI 1.06-1.92). 9 The reasons for these survival disparities are likely to be multifactorial. Many WLWH, both in South Africa and elsewhere, come from vulnerable populations at risk for poor cancer outcomes.…”

Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

“…In the United States, a double-fold increase in mortality among HIV positive patients with breast cancer was reported, with the hazard ratio range between 1.20 (95% CI, 1.14e1.26) and 2.93 (95% CI, 2.08e4.13) [25]. The recently published meta-analysis also revealed a poor overall survival among HIV positive women with breast cancer [17].…”

“…Similarly, in the USA, a high cancer-specific mortality among HIV positive patients with breast cancer [HR 2.64; 96% CI 1.86e3.73] was reported [16]. A recently published meta-analysis also demonstrated that HIV positive patients had the worst overall survival when compared to HIV negative patients [17]. But none of the published studies specifically looked at the effect of ART use on the survival of breast cancer in HIV positive patients.…”

How immunodeficiency can lead to malignancy

“…Interestingly, PLWH do not have an increased inci dence of cer tain com mon can cers, such as breast, colon, and pros tate can cer; how ever, they may pres ent at more advanced stages or with more aggres sive sub types. 5,6 NHL is the most com mon can cer among PLWH in the United States. 3 NHL is asso ci ated with mod er ate to severe immu no sup pres sion depending on the sub type (Figure 2).…”