HIV infection in breast cancer patients from Mozambique: A prospective cohort study

Abstract

Background: Insight in late treatment-related health problems following from breast cancer treatment is useful in anticipating on the (informational) needs of patients during follow-up. This study aimed to identify treatment-related health problems in breast cancer patients up to five years after diagnosis. Second, use of care associated to these health problems was identified. Methods: 876 surgically treated female patients diagnosed with early stage breast cancer (between 2012-2016) were asked to complete an online survey about current health problems and use of care. Multivariate logistic regression analyses were applied to determine the effect of patient and treatment characteristic on health problems. Results: 404 patients responded (46%). Median age was 62.0 years (SD: 10.9). Apart from breast surgery, patients were treated with radiotherapy (72%), chemotherapy (49%), anti-hormonal therapy (57%), and axillary dissection (21%). Ninety-three percent experienced one or more health problems. Over 50% of respondents experienced fatigue, psychological problems, and health problems regarding the breast, and/or musculoskeletal, central nervous, and reproductive system. Treatment with chemotherapy was significantly (p < 0.05) associated with an increased risk of health problems,

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

“…Data regarding cancer treatment received by WLWH vs HIV-negative patients were scarce (Supplemental Table 20, http://links.lww.com/QAD/B974). Still, unlike what has been reported in the USA [44], no differences were observed in terms of receipt of surgery, radiotherapy or chemotherapy between WLWH vs HIV-negative women in the Sub-Saharan African studies [6,14,17], but only one of them adjusted survival estimates for treatment [17]. Similarly, no study adjusted survival estimates to CD4+ cell count, antiretroviral therapy or to time since HIV diagnosis.…”

“…The systematic search of literature provided 10,174 unique citations, of which 62 were reviewed as full text (Figure 1). Among them, 20 publications reporting on 18 studies (including 3,174 WLWH [0.13%] and 2,394,598 HIV-negative women [99.87%]) were included: 15 assessed the likelihood of stage III/IV [6,7,[9][10][11]14,17,[24][25][26][27][28][29][30][31], 10 described each stage at diagnosis [6,7,9,14,17,24,25,27,29,31], nine reported on classic subtypes and ER status [7,9,14,17,25,26,29,31,32], four described surrogate subtypes [17,26,29,31] and seven assessed overall survival [14][15][16][17]27,33,34] -Table 1.…”

“…Four of the studies were from North America (all from the USA) [10,27,29,33,34] and 14 from Sub-Saharan Africa [6,7,9,11,[14][15][16][17][24][25][26]28,30,31]. Patient inclusion dates spanned from 1996-2018, reflecting the timing of introduction of highly active anti-retroviral treatment.…”

“…Additionally, while some reports showed that WLWH with breast cancer have an increased mortality compared to HIV-negative women, even after adjusting for stage and age [5,14], other studies did not demonstrate worse survival outcomes among WLWH [15][16][17]. These discrepancies may be due to the low number of WLWH with breast cancer and/or short follow-up time in most publications.…”

Disparities in breast cancer survival between women with and without HIV across sub-Saharan Africa (ABC-DO): a prospective, cohort study

“…6 In sub-Saharan Africa, estimates of the excess mortality seen among women with HIV (vs HIV-negative women) diagnosed with breast cancer ranged from an increase of 40-50% in South Africa and Mozambique to 80-100% in Botswana and Uganda. [7][8][9][10] Similarly, studies in the USA [11][12][13][14][15] showed an adjusted 50% and 80% increased risk for all-cause and breast cancer-specific mortality, respectively (appendix p 2). A meta-analysis reported a pooled-adjusted 90% increased risk, 16 albeit with marked between-study heterogeneity as most studies were either based on small numbers of women with HIV and, specifically in sub-Saharan Africa, had suboptimal follow-up time or losses to follow-up of greater than 40% (appendix p 2).…”