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

Abstract

In some countries of sub‐Saharan Africa, the prevalence of HIV exceeds 20%; in South Africa, 20.4% of people are living with HIV. We examined the impact of HIV infection on the overall survival (OS) of women with nonmetastatic breast cancer (BC) enrolled in the South African Breast Cancer and HIV Outcomes (SABCHO) study. We recruited women with newly diagnosed BC at six public hospitals from 1 July 2015 to 30 June 2019. Among women with stages I‐III BC, we compared those with and without HIV infection on sociodemographic, clinical, and treatment factors. We analyzed the impact of HIV on OS using multivariable Cox proportional hazard models. Of 2367 women with stages I‐III BC, 499 (21.1%) had HIV and 1868 (78.9%) did not. With a median follow‐up of 29 months, 2‐year OS was poorer among women living with HIV (WLWH) than among HIV‐uninfected women (72.4% vs 80.1%, P < .001; adjusted hazard ratio (aHR) 1.49, 95% confidence interval (CI) = 1.22‐1.83). This finding was consistent across age groups ≥45 years and <45 years, stage I‐II BC and stage III BC, and ER/PR status (all P < .03). Both WLWH with <50 viral load copies/mL and WLWH with ≥50 viral load copies/mL had poorer survival than HIV‐uninfected BC patients [aHR: 1.35 (1.09‐1.66) and 1.54 (1.20‐2.00), respectively], as did WLWH who had ≥200 CD4+ cells/mL at diagnosis [aHR: 1.39 (1.15‐1.67)]. Because receipt of antiretroviral therapy has become widespread, WLWH is surviving long enough to develop BC; more research is needed on the causes of their poor survival.

Time to Cancer Treatment and Chemotherapy Relative Dose Intensity for Patients With Breast Cancer Living With HIV

“…Decreased chemotherapy dose intensity was accompanied by an increased incidence of neutropenia. Differences in overall survival did not reach statistical significance in this small study, but the 73% increase in mortality among patients with breast cancer living with HIV is broadly consistent with larger registry-based and cohort studies from the US and sub-Saharan Africa …”

“…Differences in overall survival did not reach statistical significance in this small study, but the 73% increase in mortality among patients with breast cancer living with HIV is broadly consistent with larger registry-based and cohort studies from the US and sub-Saharan Africa. [7][8][9]31,32 We hypothesized that WLHIV might experience large delays in receipt of cancer care stemming from either structural barriers to access or the need for more intensive pretreatment evaluation. Such JAMA Network Open | Oncology delays were appreciable among patients in the SEER-Medicare database and, if present here, might contribute to poorer survival.…”

Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study

“…Our finding that HIV infection was associated with higher all-cause mortality is consistent with prior work from HICs demonstrating higher mortality rates among patients with HIV infection and breast cancer than among HIV-uninfected breast cancer patients [ 35 , 36 ]. We too have published findings showing that the 2-year overall survival of women with stages I-III breast cancer was poorer among women living with HIV than among HIV-uninfected women as reported by Ayeni et al (72.4% vs. 80.1%, p < 0.001) and adjusted hazard ratio (HR = 1.49, 95% CI = 1.22–1.83) [ 37 ]. Whilst we did not find any statistical evidence of an interaction with age, the p values were small (< 0.1); thus, in future larger studies it would be useful to reexamine whether the multimorbidity effect might be stronger at older ages.…”

Thyroid dysfunction in human immuno-deficiency virus infected patients: a non-randomized, cross-sectional, single-center study

“…opportunistic infections or tumors occurring in patients at the symptomatic stage of infection, defective function of the immune system, antiretroviral drugs used or a direct effect of HIV itself. 12 There are many studies showing correlation between HIV infection and its associated conditions like stage of infection, CD4 count, OIs, HAART and thyroiddysfunction. [13][14][15][16][17] However, these correlations are unclear.…”