Outcomes and chemotherapy-related toxicity in HIV-infected patients with breast cancer

In the era of combination antiretroviral therapy (ART), there has been a shift in the type of malignancies affecting patients with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS).1 Incidence of the three AIDS-defining malignancies (ADCs) (Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer) has significantly declined. Non-AIDS defining malignancies (NADCs) now account for a larger fraction of malignancies compared with the pre-ART era.2,3 In a recent review of the cancer burden in the HIV-infected population in the United States between 1991 and 2005,4 certain NADCs, including breast cancer, had significantly increased in incidence over time. This increase likely reflects the aging of the HIV-infected population as well as an expansion of HIV/AIDS prevalence among women in the U.S. From a global perspective, breast cancer is the most frequently diagnosed malignancy in women, representing 23% of all cancer cases and 14% of cancer deaths.5 It is the leading cause of cancer death in females in the developing world.5 In the past, the incidence of breast cancer has been lower in the AIDS population compared to the general population,6,7 with little variation in incidence by CD4 count or duration of HIV infection.8 However, the incidence of breast cancer in HIV-infected patients is increasing over time and now approaches the general population risk.9 African-Americans account for nearly half of new HIV infections in the U.S. despite comprising a minority of the general U.S. population.10 Eighty-five percent of HIV/AIDS patients are African-American in Baltimore city.11 For some cancers, including breast cancer, inferior treatment outcomes have been reported both for African-Americans12–15 and for HIV-infected patients.16 The impact of cancer on urban, predominantly African-American, HIV-infected patients in the late ART era is understudied. Given these shifts in cancer incidence and the changing face of the HIV epidemic in this country, we sought to better understand the characteristics and outcomes of breast cancer in HIV-infected patients at our large, urban, academic medical center in Baltimore, Maryland.