Study Finds No Treatment Delays but Suboptimal Chemotherapy in Breast Cancer Patients Living with HIV

A study recently published in JAMA Network Open highlights the challenges faced by breast cancer patients who are also living with HIV.

Advances in antiretroviral therapy has extended the life expectancy of people with HIV in the US. This has led to an aging population of people living with HIV. Consequently, non-AIDS-related cancer cases, including breast cancer, have increased among people with HIV. People with HIV do not have an increased risk of developing breast cancer but tend to have worse outcomes once diagnosed with disease.

Daniel O'Neil, M.D., M.P.H.

“It has been well established that breast cancer patients who are also living with a comorbid HIV infection have higher mortality than breast cancer patients without HIV. However, there is limited research on exactly why those disparities exists,” lead author Daniel O’Neil, M.D., M.P.H., assistant professor of medicine at Yale Institute for Global Health, said in an email interview with Managed Healthcare Executive.

To investigate, O’Neil and a team of researchers across three US urban academic institutions set out to evaluate the impact of HIV on breast cancer care by comparing time to treatment initiation and chemotherapy dose intensity among different groups.

O'Neil and his colleagues used electronic medical record systems to identify individuals with breast cancer and HIV who met specific eligibility criteria. They ended up with a group of 198 women diagnosed with stage I to III breast cancer, of whom 66 were infected with HIV. The study also included 132 patients with breast cancer but no HIV that for the purposes of this study served as controls. Additionally, the researchers identified subgroups of participants who had received neoadjuvant (before surgery) or adjuvant (after surgery) chemotherapy for breast cancer

The results showed that breast cancer patients with HIV did not experience significant delays in starting cancer treatment compared to those without HIV. However, among patients who received neoadjuvant or adjuvant chemotherapy, those with HIV had a lower median chemotherapy relative dose intensity (RDI) of 0.87, compared to 0.96 in patients without HIV. This suggests that breast cancer patients with HIV may be more likely to receive suboptimal adjuvant chemotherapy.

“Our study looked for differences in the quality of breast cancer care received by potentially curable patients with and without comorbid HIV, and we found that those patients with HIV were less likely to receive full dose, on-schedule adjuvant chemotherapy,” O’Neil explained.

“In addition, we found some preliminary evidence of increased myelotoxicity in patients living with HIV, which could explain some of those chemotherapy delays and dose reductions,” he said.

Adverse reactions related to treatment were also examined in the study. Severe neutropenia, a condition characterized by low white blood cell counts and increased risk of infection, occurred more frequently in breast cancer patients with HIV during chemotherapy (36.1% vs. 8.6% without HIV). This difference underscores the potential for reduced tolerance to chemotherapy among patients with longstanding HIV infection.

In the JAMA Network Open paper, which was published Dec.5, the authors acknowledged the limitations of a small sample size and the need for further research to validate their findings. However, this study offers valuable insights into areas for improvement of cancer care at the intersection of breast cancer and HIV.

“Providers caring for breast cancer patients with comorbid HIV should be aware of those women’s increased risk for sub-optimal chemotherapy receipt and anticipate both issues with access and toxicity,” O’Neil said. He further stated that strategies for prevention of toxicity among breast cancer patients with HIV, such as earlier and less restrictive use of myeloid growth factors, deserve further consideration.