Incidence of chemotherapy-induced neutropenia in HIV-infected and uninfected patients with breast cancer receiving neoadjuvant chemotherapy

Abstract

Background. Chemotherapy-induced neutropenia (CIN) can result in poor tolerance of chemotherapy, leading to dose reductions, delays in therapy schedules, morbidity and mortality. Actively identifying predisposing risk factors before treatment is of paramount importance. We hypothesised that chemotherapy is associated with a greater increase in CIN and its complications in HIV-infected patients than in those who are not infected. Objective. To establish the incidence of CIN in HIV-infected and uninfected patients undergoing chemotherapy. Methods. A retrospective chart review and analysis was conducted in the oncology departments at Inkosi Albert Luthuli Central Hospital and Addington Hospital, Durban, South Africa. The study population consisted of 65 previously untreated women of all ages with stage II -IV breast cancer and known HIV status treated with neoadjuvant chemotherapy from January 2012 to December 2015. Results. HIV-infected patients formed 32.3% of the group, and 95.2% of them were on antiretroviral therapy. The mean age (standard deviation (SD)) of the cohort was 48.5 (13.2) years (40.6 (9.6) years for the HIV-infected group v. 52.0 (13.1) years for the uninfected group; p<0.001). Ninety-five neutropenia episodes were observed (rate 0.85 per 1 year of follow-up time). Following multivariate adjustment, patients with HIV infection were almost two times more likely to develop CIN (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.06 -2.92; p=0.029. A high baseline absolute neutrophil count (ANC) (HR 0.80, p=0.005) remained significantly associated with protection against CIN. Conclusions. HIV-infected patients were younger than those who were not infected, and presented at a more locally advanced stage of disease. HIV infection was an independent predictor for CIN. HIV-infected patients had an almost two-fold increased risk of developing CIN and developed neutropenia at a much faster rate. A high baseline white cell count and ANC were protective against CIN.

Breast cancer in women living with HIV: A first global estimate

“…In addition to further survival studies, research needs to address side‐effects and survivorship, with relevant studies currently underway . Clinically, concerns have been raised related to delays in initiating primary or adjuvant chemotherapy in highly immuno‐suppressed patients, HAART‐chemotherapy interactions, and a higher incidence of intolerance to, and side‐effects of, chemotherapy, including chemotherapy‐induced neutropenia, which are often exacerbated in the HIV‐positive cancer patient . In palliative care patients in South Africa and Uganda, Selman et al .…”

Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region

“…5,34,53,59,73,74,80-82 In the ONCOVIH study (France), consisting of 21 BCs in WLWHA, the median CD4 cell count was 347 cells/mm 3 (range: 180-1039), 51 while in Durban, South Africa the median CD4 count was 435 cells/mm 3 (range 80-945). 77 BC in WLWHA is certainly not associated with a low CD4 count 34 implying that the degree of immune-compromise does not correlated with tumorigenesis. 82…”

“…9 More recent legitimately credible studies from SSA also demonstrated no statistically significant difference in the stage at presentation, histologic subtype, tumor grade, or nodal involvement between HIV-positive groups and the other groups. 7,75,77,86…”

“…More recently Nigidi et al narrated that patients with HIV infection were almost two times more likely to develop neutropenia than their HIV-negative counterparts (hazard ratio 1.76, [95% CI 1.06-2.92]; P=0.029). 77 Ninety five percent of patients were on HAART. It seems HAART did not prevent patients with HIV infection from experiencing neutropenia, but it did protect them from developing higher grades of neutropenia and more severe complications.…”

“…It seems HAART did not prevent patients with HIV infection from experiencing neutropenia, but it did protect them from developing higher grades of neutropenia and more severe complications. 77…”