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

• Published in: International journal of cancer Vol. 151; no. 2; pp. 209 - 221
• Main Authors: Ayeni, Oluwatosin A, O'Neil, Daniel S, Pumpalova, Yoanna S, Chen, Wenlong Carl, Nietz, Sarah, Phakathi, Boitumelo, Buccimazza, Ines, Čačala, Sharon, Stopforth, Laura W, Farrow, Hayley A, Mapanga, Witness, Joffe, Maureen, Chirwa, Tobias, McCormack, Valerie, Jacobson, Judith S, Crew, Katherine D, Neugut, Alfred I, Ruff, Paul, Cubasch, Herbert
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.07.2022
• Subjects: Antiretroviral therapy; Breast cancer; Breast Neoplasms - epidemiology; Cancer; CD4 antigen; Female; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infections; Medical research; Middle Aged; Proportional Hazards Models; South Africa - epidemiology; Viral Load; South Africa; overall survival; South Africa; breast cancer; HIV
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.33981

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.