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Impact of HIV infection on overall survival among women with stage IV breast cancer in South Africa

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Advanced breast cancer (BC) at diagnosis is common in sub-Saharan Africa (SSA), including among women living with HIV (WLWH). In public hospitals across South Africa (SA), 10–15% of women present with stage IV BC, compared to < 5% in the United States (US); 20% of new BC diagnoses in SA are in WLWH. We evaluated the impact of HIV on overall survival (OS) among women with stage IV BC.

Methods

We conducted a prospective cohort study of women diagnosed with stage IV BC between February 2, 2015 and September 18, 2019 at six public hospitals in SA. Multivariate Cox regression models were used to estimate the association between HIV status and OS.

Results

Among 550 eligible women, 147 (26.7%) were WLWH. Compared to HIV-negative BC patients, WLWH were younger (median age 45 vs. 60 years, p < 0.001), predominantly black (95.9% vs. 77.9%, p < 0.001), and more likely to have hormone receptor-negative (hormone-negative) BC (32.7% vs. 22.6%, p = 0.016). Most women received systemic cancer-directed therapy (80.1%). HIV status was not associated with treatment or OS (Hazard Ratio (HR) 1.13 [95%CI 0.89–1.44]). On exploratory subgroup analysis, WLWH and hormone-negative BC had shorter OS compared to HIV-uninfected women (1-year OS: 27.1% vs. 48.8%, p = 0.003; HR 1.94 [95%CI 1.27–2.94]; p = 0.002), which was not observed for hormone receptor-positive BC.

Conclusion

HIV status was not associated with worse OS in women with stage IV BC in SA and cannot account for the poor survival in this cohort. Subgroup analysis revealed that WLWH with hormone-negative BC had worse OS, which warrants further investigation.

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Availability of data and material

The datasets generated during an/or analyzed during the current study are available from the corresponding author in reasonable request.

Abbreviations

ART:

Antiretroviral therapy

BC:

Breast cancer

BMI:

Body mass index

IQR:

Interquartile range

HR:

Hazard ratio

OS:

Overall survival

SA:

South Africa

SABCHO:

South African Breast Cancer and HIV Outcomes study

SSA:

sub-Saharan Africa

US:

United States of America

WLWH:

Women living with HIV

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Funding

This study was funded by NIH grant (NCI R01CA192627 and R01CA250012) to Drs. Jacobson, Joffe, Neugut and Ruff; a University of Witwatersrand/South African Medical Research Council / University of the Witwatersrand Common Epithelial Cancer Research Centre grant to Dr. Ruff; and Dr. Neugut is funded in part by CCSG P30 CA13696. Dr. O'Neil is a K12 Scholar supported by the National Cancer Institute of the National Institutes of Health under Award Number K12CA226330. Dr. Pumpalova is funded by NIH T32 training grant (T32 CA094061) awarded to the Department of Epidemiology at the Columbia University Mailman School of Public Health.

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Authors and Affiliations

  1. Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Yoanna S. Pumpalova, Katherine D. Crew & Alfred I. Neugut

  2. Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa

    Oluwatosin A. Ayeni, Wenlong Carl Chen, Sarah Nietz, Boitumelo Phakathi, Ines Buccimazza, Sharon Čačala, Laura W. Stopforth, Hayley A. Farrow, Maureen Joffe, Witness Mapanga, Herbert Cubasch & Paul Ruff

  3. SAMRC/Wits Developmental Pathways To Health Research Unit, Department of Pediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Oluwatosin A. Ayeni & Maureen Joffe

  4. South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa

    Oluwatosin A. Ayeni, Maureen Joffe, Herbert Cubasch & Paul Ruff

  5. National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa

    Wenlong Carl Chen

  6. Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Wenlong Carl Chen

  7. Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA

    Daniel S. O’Neil

  8. Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Sarah Nietz, Boitumelo Phakathi & Herbert Cubasch

  9. Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa

    Ines Buccimazza

  10. Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa

    Sharon Čačala, Laura W. Stopforth & Hayley A. Farrow

  11. Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Witness Mapanga & Paul Ruff

  12. Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Judith S. Jacobson, Katherine D. Crew & Alfred I. Neugut

  13. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Judith S. Jacobson, Katherine D. Crew & Alfred I. Neugut

  14. Division of Medical Oncology, Columbia University Irving Medical Center, 722 West 168th Street, Room 725, New York, NY, 10032, USA

    Alfred I. Neugut

Authors
  1. Yoanna S. Pumpalova
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  2. Oluwatosin A. Ayeni
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  3. Wenlong Carl Chen
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  4. Daniel S. O’Neil
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  5. Sarah Nietz
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  6. Boitumelo Phakathi
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  7. Ines Buccimazza
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  8. Sharon Čačala
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  9. Laura W. Stopforth
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  10. Hayley A. Farrow
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  11. Maureen Joffe
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  12. Witness Mapanga
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  13. Judith S. Jacobson
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  14. Katherine D. Crew
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  15. Herbert Cubasch
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  16. Paul Ruff
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  17. Alfred I. Neugut
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Contributions

Conceptualization of this study, including cohort design and study aims, were developed by HC, JJ, MJ, AIN, YSP, and PR. JJ, MJ, AIN, and PR were responsible for funding acquisition. Power calculations were prepared by OAA. Project administration was overseen by HAF, MJ, and AIN. Investigation was carried out by all authors. Data curation was done by HAF, WM, and OSS. Statistical analysis was done by OAA, DSN, and YSP. All authors contributed to interpretation of results. Figures and tables were prepared by YSP. YSP was responsible for writing the manuscript draft and all authors contributed to reviewing and editing the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Alfred I. Neugut.

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Conflict of interest

Dr. Neugut has received consulting fees from Otsuka, United Biosource Corp, Hospira, Eisai, and GlaxoSmithKline, and is on the medical advisory board of EHE Intl. He has also received research funding from Otsuka. Dr. Ruff has received honoraria from Sanofi, Amgen, and Roche and research funding from Amgen, Sanofi, Merck and Novartis. All other authors declare they have no conflicts of interest.

Ethical approval

Approval was obtained from the ethics committees of Columbia University and the University of Witwatersrand. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Supplementary Information

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10549_2021_6265_MOESM1_ESM.pdf

Overall Survival in HIV-Positive Women with Stage IV Breast Cancer Enrolled in the SABCHO cohort (2015-2019), by (A) CD4 count, (B) Length of Time on Antiretroviral Treatment and (C) HIV Viral Load at Breast Cancer Diagnosis. Supplementary file1 (PDF 995 kb)

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Pumpalova, Y.S., Ayeni, O.A., Chen, W.C. et al. Impact of HIV infection on overall survival among women with stage IV breast cancer in South Africa. Breast Cancer Res Treat 189, 285–296 (2021). https://doi.org/10.1007/s10549-021-06265-w

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  • DOI: https://doi.org/10.1007/s10549-021-06265-w

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