Impact of HIV infection on baseline characteristics and survival of women with breast cancer: A systematic review and meta-analysis

BACKGROUND: As women living with HIV (WLWH) become older, their risk of developing breast cancer increases. Nonetheless, literature is conflicting regarding tumor stage, distribution of subtypes and overall survival among WLWH vs HIV-negative women with breast cancer. We assessed differences in clinicopathological characteristics and overall survival between these two groups. METHODS: Systematic review and meta-analysis using MEDLINE, Scopus, ISI Web of Knowledge, LILACS, SciELO and conference abstracts up to 1/January/2020. Cross-sectional/cohort studies comparing baseline characteristics (stage and/or subtypes) and/or overall survival of WLWH vs HIV-negative women with breast cancer were included. We performed random-effects meta-analyses to estimate summary statistics and subgroup analyses according to region of the world. RESULTS: 18 studies (4 from North America, 14 from Sub-Saharan Africa [SSA]) were included, with 3,174 WLWH and 2,394,598 HIV-negative women. WLWH from North America and SSA were more likely to present with stage III/IV disease compared to HIV-negative women – pooled odds ratio (pOR) 1.76 (95% confidence interval [CI]:1.58-1.95) and pOR 1.23 (95%CI:1.06-1.42), respectively. WLWH from SSA were also less likely to have estrogen receptor-positive/HER2-negative tumors (pOR 0.81; 95%CI:0.66-0.99). After adjustment, WLWH had worse overall survival compared to HIV-negative women, both in North America (pooled adjusted hazard ratio [aHR] 2.45; 95%CI:1.11-5.41) and SSA (aHR 1.43; 95%CI:1.06-1.92). CONCLUSIONS: Compared to HIV-negative women, WLWH are diagnosed with breast cancer at a more advanced stage and have a worse overall survival. These results should raise awareness regarding the detection and survival gap among WLWH with breast cancer and further studies are needed to decipher the reasons behind these disparities.

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • Women
  • Older adults (>50 years)
• Co-morbidities
  • Cancer