It would also be observed a lower survival to this cancer due to HIV
A systematic review of studies conducted with women in the United States and sub-Saharan Africa, published in AIDS, has concluded that women with HIV have a diagnosis of breast cancer in more advanced stages than those without the infection. Consistent with this first finding, the study revealed that survival would be lower in HIV-positive women than in HIV-negative women. According to the results of the review, this effect would be observed with more intensity in American women than in sub-Saharan women.
As women with HIV age, their risk of developing breast cancer increases. However, the existing medical literature to date presents some controversy and lack of data regarding the existing differences in terms of HIV serological status in terms of phase of infection at the time of diagnosis, subtypes and survival in relation to to breast cancer.
To shed more light on this issue, the authors of this systematic review and meta-analysis focused on measuring clinicopathological differences and overall survival relative to breast cancer in HIV-positive women and comparing them with HIV-negative women.
A total of 18 studies were included in the review, which included 3,174 women with HIV and 2.3 million women without HIV. All of them had been diagnosed with breast cancer.
Four of the studies were conducted in the US (involving 1,638 women with HIV) and the remaining 14 (involving 1,536 women with HIV) were conducted in sub-Saharan Africa. The US studies did not include data on participants' CD4 levels or the percentage of participants on antiretroviral treatment. In these studies, the percentage of seropositive women of black ethnicity ranged between 45% and 91%, while in the group of seronegative the participants were mostly of non-black ethnicity.
Sub-Saharan African women with HIV were 23% more likely to be diagnosed with late-stage breast cancer than those without HIV in that setting (odds ratio [LR]: 1.23; confidence interval of the 95% [95% CI]: 1.06-1.42). In the United States, this difference was even greater, since in this environment, women with HIV had a 76% higher probability than that observed in seronegative women of being diagnosed with advanced-stage breast cancer (LR: 1.76; 95% CI: 1.58-1.95).
HIV-positive women in sub-Saharan Africa had a significantly lower probability of developing estrogen receptor-positive and HER2-negative biomarker breast cancers (easier-to-treat tumors) than US HIV-positive women (OR: 0.81; 95% CI : 0.66-0.99).
In terms of overall survival, outcomes were also worse in women with HIV, both in sub-Saharan Africa (adjusted hazard ratio [aHR]: 1.43; 95% CI: 1.06- 1.92) and especially in the USA (aHR: 2.45; 95% CI: 1.11-5.41). In this case, the large difference observed between the two groups of women was due to the inclusion of an American study that recorded high mortality rates. In any case, even excluding this study, mortality in HIV-positive women remained higher in the United States than in sub-Saharan Africa.
The present study has important limitations (such as not having essential clinical data in women with HIV such as CD4 levels, viral load or the percentage of participants in antiretroviral treatment), which make it difficult to interpret the results and even to determine the comparison of the same between the two geographical areas compared. In any case, what does seem consistent is that late diagnosis is more frequent in HIV-positive women than in HIV-negative women and that this affects survival rates. Therefore, screening for breast cancer in women with HIV should be a priority and included in the routine follow-up of women with HIV to try to correct this observed diagnostic mismatch.
Source: POZ / Elaboración propia (gTt-VIH)
References: Brandão M, Bruzzone M, Franzoi MA, et al. Impact of HIV infection on baseline characteristics and survival of women with breast cancer. AIDS. 2021 Mar 15;35(4):605-618. doi: 10.1097/QAD.0000000000002810. PMID: 33394680.