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

Date 03 May 2019
Event ESMO Breast Cancer 2019
Session Poster lunch
Topics Breast Cancer
Cancer Treatment in Patients with Comorbidities
Presenter Mariana Brandão
Citation Annals of Oncology (2019) 30 (suppl_3): iii65-iii71. 10.1093/annonc/mdz101
Authors M.D.R.A. Brandão1, A. Guisseve2, G. Bata3, G. de Morais3, M. Alberto2, F. Schmitt4, C. Lorenzoni2, S. Tulsidás3, N. Lunet5, C. Carrilho2
  • 1Academic Promoting Team, Institut Jules Bordet, 1000 - Brussels/BE
  • 2Pathology Department, Maputo Central Hospital, Maputo/MZ
  • 3Oncology Unit, Maputo Central Hospital, Maputo/MZ
  • 4Pathology Department, Institute of Molecular Pathology and Immunology, Porto/PT
  • 5Epiunit – Instituto De Saúde Pública, Universidade do Porto, Porto/PT

Abstract

Background

Breast cancer (BC) burden is increasing among women living with HIV (HIV+). Yet, data regarding epidemiology, BC presentation, treatment, and prognosis is still scarce, especially among HIV+ BC patients (pts) from developing countries.

Methods

This prospective cohort included BC patients diagnosed at the Maputo Central Hospital, Mozambique, from Jan-2015 to Mar-2017. Data on demographics, BC risk factors, co-morbidities, treatment, and survival were prospectively collected. Chi2 and t tests were used to compare categorical and continuous variables, respectively. Time-to-event outcomes were estimated using Kaplan-Meier methods. Survival estimates were compared using log-rank test and Cox proportional hazards models. All tests were two-tailed and results were considered significant if p-value was <.05.

Results

Among 205 pts included, 98% were black and 52 (25%) were HIV+. HIV+ pts were younger than HIV- pts (median age: 44.5 vs 51.0 years respectively, p=.002), and most had stage III/IV BC (81% vs 71%, p=.204). Among HIV+ pts, 90% had a CD4+ cells count > 200/μL and 26% were diagnosed at the time of BC. Immunohistochemistry analysis was performed in 152 pts and showed that HIV+ pts had a higher proportion of triple-negative BC (TNBC) compared to HIV- pts (37.5% vs 20.5%, p=.029). Among pts with early BC (EBC), there were no significant differences in local treatments received; yet, HIV+ pts tended to receive a lower chemotherapy (CT) dose-intensity (DI) compared to HIV- pts (DI < 85%: 69.4% vs 50.0%, p=.057). Median overall survival (OS) was 31.0 months (m) in HIV+ pts and 34.0 m in HIV- pts (unadjusted hazard ratio [HR] 1.52, 95% confidence interval [CI] 0.92 – 2.51). In EBC pts, median disease-free survival was 27.0 m in HIV+ pts and 31.0 m in HIV- pts (HR 1.37, 95% CI 0.81-2.31).

Conclusions

Our results show that in Southeast Africa the proportion of HIV+ women among BC pts can be very high. These pts were diagnosed at a younger age and had a significantly higher proportion of TNBC compared to HIV- pts. They tended to receive lower CT DI, and their survival was worse as compared to HIV- pts, although not statistically different. This highlights the need for better understanding BC biology in HIV+ pts and to provide effective cancer care to this underserved population.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Faculty of Medicine, Eduardo Mondlane University, Mozambique.

Funding

NIH AORTIC BIG CAT grant (award number 59-210-6-004).

Disclosure

M.D.R.A. Brandão: Research grants to my Institute: Roche, Menarini Silicon Biosystems, Pfizer, Janssen Diagnostics. All other authors have declared no conflicts of interest.