Breast cancer diagnosed in women with the Human Immune-Deficiency Virus (HIV)

Langenhoven, Lizanne (2014-12)

Thesis (MMed)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Background: HIV is the defining pandemic of our era, with an estimated 5.9 million people infected in South Africa according to World Health Organization (WHO) estimates for 2011. The expression and treatment of non-AIDS defining cancers has become an important consideration in this cohort, as antiretroviral therapy (ART) has prolonged survival in a subgroup previously at risk of early mortality. Study Design: A retrospective cohort study of all women seen at the Combined Breast Cancer Clinic at Tygerberg Hospital between January 2010 and December 2011, stratified into three subgroups based on HIV status. Methods: Of the 816 patients screened, 586 met inclusion criteria; of which 31 (5.3%) patients were HIV positive, 420 (71.7%) HIV negative, and 135 (23%) had an unknown HIV status. The disease phenotype was described in each subgroup, as well as toxicities associated with standard chemotherapy regimens, with an emphasis on completion rates of systemic cytotoxic treatment. The insult of cytotoxic therapy to the CD4 count was described for this cohort. Results: Women with HIV had a statistically significant (p<0.001) younger age at presentation of breast cancer with a median age of 42 years (range 39 – 45 years) in comparison with the HIV-negative cohort with a median age of 54 years (range 53 – 55 years) . No difference was detected in disease phenotype when stage at presentation (p=0.7874), histological subtype (p=0.3375), grade of differentiation (p=0.8297), nodal involvement (p=0.0998) or hormone-receptor positivity (p=0.6285) was considered. Completion rates for systemic chemotherapy were excellent (>90%) regardless of HIV-status and no statistically significant toxicity was observed. The median CD4 count at diagnosis was 477 cells/μL (range 234 – 807 cells/μL), with a nadir value of 333 cells/μL (range 62 – 713 cells/μL), representing a decrease of 30.2% during treatment. One case of suspected treatment-related mortality was recorded. Conclusion: This retrospective study confirmed that women infected with HIV had a younger age at breast cancer diagnosis when compared to women with a negative HIV-status. No difference in disease phenotype could be demonstrated for women with HIV, denoting the coexistence of two common chronic diseases. Chemotherapy was tolerated well, but caused a median decline in CD4-count of 30% during treatment.

AFRIKAANSE OPSOMMING: Agtergrond: Infeksie met die Menslike Immuungebrek-Virus (MIV) is die pandemie van ons era, met ‘n geraamde 5.9 miljoen mense geïnfekteerd in Suid-Afrika volgens die Wêreld Gesondheids-Organisasie (WGO) in 2011. Kankers wat nie met MIV geassosieer word nie, het n belangrike oorweging in hierdie populasie-groep geword as gevolg van die gebruik van anti-retrovirale terapie wat die lewensverwagting van mense met MIV verleng. Navorsingsontwerp: ‘n Retrospektiewe kohort studie van alle vroue wat tydens die tydperk Januarie 2010 en Desember 2011 by die Gekombineerde Borskanker Kliniek te Tygerberg Hospitaal behandel was, verdeel in 3 groepe volgens hul retrovirale status. Metodes: ‘n Totaal van 819 vroue was oorweeg vir insluiting in die studie, waarvan 586 aan die insluitingskriteria voldoen het. Daar was 31 vroue met MIV (5.3%), 420 vroue het MIVnegatief getoets (71.7%), en 135 (23%) vroue waarvan die MIV-status onbekend was. Die fenotipe van borskanker was beskryf vir elke sub-groep, sowel as die toksiteite wat geassosieer word met die gebruik van standaard chemoterapie-skedules, insluitend die effek van chemoterapie op die CD4-telling. Bevindinge: Vroue met MIV het op ‘n statisties noemenswaardige (p<0.001) jonger ouderdom gepresenteer met borskanker (gemiddelde ouderdom 42 jaar, reikwydte 39 – 45 jaar) in vergelyking met vroue wat MIV-negatief was (gemiddelde ouderdom 54 jaar, reikwydte 53 – 55 jaar). Geen verskil was waargeneem in die fenotipe van borskanker in vroue met MIV vir die stadium by diagnose (p = 0.7874), histologiese tipe (p=0.3375), graad van differensiasie (p = 0.8297), nodale betrekking (p = 0.0998) of hormoon-reseptor status (p=0.6285) nie. Voltooing van sistemiese chemoterapie is bereik in meer as negentig persent van gevalle onafhanklik van MIV-status. ‘n Gemiddelde CD4-telling van 477 selle/μL (reikwydte 234 – 807 selle/ μL) met diagnose het ‘n gemiddelde afname van 30.2% tydens behandeling getoon na ‘n gemiddelde waarde van 333 selle/ μL (reikwydte 62 – 713 selle/ μL). Gevolgtrekkings: Hierdie retrospektiewe studie het bevind dat vroue met MIV op ‘n jonger ouderdom met borskanker presenteer as vroue wat MIV-negatief is. Geen noemenswaardige verskil was waargeneem in die fenotipe van borskanker in vroue met MIV nie, en dui daarop dat borskanker en MIV twee algemene, maar onafhanklike entiteite is. Chemoterapie was goed getolereer met ‘n gemiddelde afname in die CD4-telling van 30.2% tydens chemoterapie.

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