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
Menée en Afrique du Sud à partir de données portant sur 2 367 patientes atteintes d'un cancer du sein de stade I à III (durée médiane de suivi : 29 mois), cette étude analyse l'effet d'une infection par le VIH (499 cas) sur la survie globale
Résumé en anglais
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 non-metastatic 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 July 1, 2015, to June 30, 2019. Among women with stages I-III BC, we compared those with and without HIV infection on socio-demographic, 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<0.001; 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<0.03). 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 are surviving long enough to develop BC; more research is needed on the causes of their poor survival. This article is protected by copyright. All rights reserved.