Sir,

Breast carcinoma is the second most common cause of female cancer deaths in the United States of America [1]. There has been no demonstrated association between HIV infection and breast cancer. The acquired immunodeficiency syndrome (AIDS) defining neoplasms are Kaposi’s sarcoma, non-Hodgkin lymphoma, and cervical cancer [2]. There are malignancies that are more prevalent in AIDS patients than general population. They are called non-AIDS defining cancers (NADCs) such as Hodgkin’s lymphoma, squamous cell carcinoma of anus, liver cancer, head and neck and lung cancer [3]. The data about breast cancer incidence and prognosis in HIV patients are limited and conflicting although most recently, it has been stipulated that breast cancer is more aggressive in the HIV-infected patient. To explore the relationship of HIV infection and breast cancer, we have reviewed our experience at St Michael’s Medical Center (SMMC) where over 1,000 patients are treated annually for HIV infection.

We reviewed the data of 12 HIV patients in the tumor registry records who were diagnosed with breast cancer between January 1997 and December 2007 with attention to sex, age, race/ethnicity, HIV variables including CD4 count and viral load, disease stage at presentation, tumor characteristics, and patient survival.

The twelve HIV-infected patients with breast cancer had a mean age of 54 ranging from 47 to 70. There was only one man. Breast carcinoma was diagnosed from 8 months to 8 years after the patient was tested positive for HIV, with a median of two and a half years. The mode of HIV transmission was mainly unprotected sex. The median CD4 count was 410.25% were diagnosed at stage I, 50% were staged at 2/3 and 25% at stage IV. Three tumors were triple negative. The median BMI was 24.9.33% of the patients underwent chemotherapy with poor tolerance. About 33% of HIV-infected breast cancer patients had negative survival outcomes and 100% of them were secondary to breast cancer complications. And 50% of the breast cancer survivors have lived for more than 5 years after being treated with surgery and tamoxifen.

Most patients reported had a CD4 count, which was above the threshold considered critical for significant immunosuppression suggesting that, the degree of immunocompromise (i.e., CD4 count) is not correlated with tumorigenicity. Our results demonstrate that the decision of chemotherapy should be a cautious one with HIV-infected breast cancer patients with poorly differentiated, aggressive disease because of potential fatal complications. Whether this factor is related to a more aggressive breast cancer associated with HIV in addition to the inability to administer full systemic chemotherapy doses is a subject that needs to be studied further [4].

HIV can augment the immunosuppression induced by chemotherapy but it is also possible that chemotherapy can accelerate the progression of HIV disease. It still remains unclear if breast carcinoma can be directly linked to HIV infection.