Breast Cancer and HIV: State of the Art and Practical Implications

Breast cancer is most common in women, and its incidence in HIV population, after the introduction of antiretroviral therapy, has increased to a level approaching that of the general population. This review will be focused on breast cancer in HIV-positive patients with particular reference to epidemiology, screening strategies, clinico-pathological features, and treatment, including the interaction between chemotherapy and HAART. Recent cohort studies on HIV-positive women have clearly shown a shift towards increasing breast cancer incidence, with levels now approaching those in the HIV-negative population. Screening disparities exist yet between HIV-positive and HIV-negative women emphasizing the importance of biennial mammography to detect early breast cancer in women aged 50–74 years, who live with HIV/AIDS. Cancer stage, cancer pathology characteristics, and survival outcome are similar in HIV-positive and HIV-negative patients, although the fear of additional complications and toxicity often leads to HIV-positive patients receiving sub-optimal treatment. The best management of breast cancer in HIV patients consists in a multidisciplinary approach between oncologists and infectious disease specialists to guarantee the patients the correct diagnostic work-up and the most appropriate therapeutic approach aiming to reduce drug-drug interactions and overlapping toxicities of both treatments.