Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV
Boitumelo Phakathi,
Sarah Nietz,
Herbert Cubasch,
Caroline Dickens,
Therese Dix-Peek,
Maureen Joffe,
Alfred I. Neugut,
Judith Jacobson,
Raquel Duarte,
Paul Ruff
Affiliations
Boitumelo Phakathi
Charlotte Maxeke Surgical Breast Unit. Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Johannesburg, 2196 South Africa; Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa; Corresponding author. Department of Surgery, University of Witwatersrand Faculty of Health Sciences, 7 York Road, Parktown 2193, Johannesburg. South Africa.
Sarah Nietz
Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa
Herbert Cubasch
Department of Surgery, University of the Witwatersrand, Faculty of Health Sciences, 7 York Road, Johannesburg 2193 South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Soweto, 1860 South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa
Caroline Dickens
Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
Therese Dix-Peek
Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
Maureen Joffe
Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa; MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
Alfred I. Neugut
Herbert Irving Comprehensive Cancer Centre, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
Judith Jacobson
Herbert Irving Comprehensive Cancer Centre, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Raquel Duarte
Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
Paul Ruff
Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Building, Johannesburg, 2193 South Africa; Department of Medicine, University of Witwatersrand Faculty of Health Sciences, 7 York Road Johannesburg, South Africa
Purpose: Breast cancer outcomes in sub-Saharan Africa is reported to be poor, with an estimated five-year survival of 50% when compared to almost 90% in high-income countries. Although several studies have looked at the effect of HIV in breast cancer survival, the effect of ARTs has not been well elucidated. Methods: All females newly diagnosed with invasive breast cancer from May 2015–September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital were enrolled. We analysed overall survival and disease-free survival, comparing HIV positive and negative patients. Kaplan-Meier survival curves were generated with p-values calculated using a log-rank test of equality while hazard ratios and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results: Of 1019 patients enrolled, 22% were HIV positive. The overall survival (95% CI) was 53.5% (50.1–56.7%) with a disease-free survival of 55.8% (52.1–59.3) after 4 years of follow up. HIV infection was associated with worse overall survival (HR (95% CI): 1.50 (1.22–1.85), p < 0.001) and disease-free survival (OR (95% CI):2.63 (1.71–4.03), p < 0.001), especially among those not on ART at the time of breast cancer diagnosis. Advanced stage of the disease and hormone-receptor negative breast cancer subtypes were also associated with poor survival. Conclusion: HIV infection was associated with worse overall and disease-free survival. HIV patients on ARTs had favourable overall and disease-free survival and with ARTs now being made accessible to all the outcome of women with HIV and breast cancer is expected to improve.
