University of the Witwatersrand, Johannesburg, South Africa.
Breast Cancer Res Treat. 2013 Jul;140(1):177-86. doi: 10.1007/s10549-013-2606-y. Epub 2013 Jun 26.
In the low-income HIV-endemic regions of sub-Saharan Africa, malignancies related to HIV have long been recognized as a major public health problem. However, epithelial malignancies associated with older age, such as breast cancer, are also rising dramatically in those regions. We compared consecutive HIV-positive and -negative black women diagnosed with breast cancer at a large public hospital in Soweto, South Africa, on age, year of diagnosis, stage, grade, and receptor status, and grouped HIV-positive patients by CD4 cell counts. We computed prevalence ratios of the associations of HIV status and CD4 category with stage, grade, receptor status, and among the HIV-positive patients, receipt of ART, controlling for age and year of diagnosis. Of 1,092 patients, 765 were tested for HIV; 151 (19.7 %) tested positive, a prevalence similar to that in the source population. Although, HIV-positive patients were younger than HIV-negative patients (p < 0.001), HIV status was not associated with the tumor characteristics. Thirty-seven women (25.9 %) had CD4 cell counts <200 cells/μl. Patients in that severely immunocompromised group were older than those in the other groups (p = 0.01). This study is the first to analyze the association of HIV with breast cancer in a large sample. Based on similar HIV prevalence in our sample and the population of the hospital's catchment area, clinicians serving HIV-endemic communities should promote routine HIV testing of younger breast cancer patients and immediate treatment of those who test positive, prior to the initiation of chemotherapy. Research is needed on treatment and outcomes given HIV and low CD4 cell count.
在撒哈拉以南非洲的低收入艾滋病毒流行地区，与艾滋病毒相关的恶性肿瘤长期以来一直被认为是一个主要的公共卫生问题。然而，与年龄相关的上皮性恶性肿瘤，如乳腺癌，在这些地区也急剧上升。我们比较了在南非索韦托的一家大型公立医院连续诊断为乳腺癌的艾滋病毒阳性和阴性黑人妇女的年龄、诊断年份、分期、分级和受体状态，并根据 CD4 细胞计数对艾滋病毒阳性患者进行分组。我们计算了艾滋病毒状况和 CD4 类别与分期、分级、受体状态的关联的患病率比，并在艾滋病毒阳性患者中，控制年龄和诊断年份，比较了接受抗逆转录病毒治疗的情况。在 1092 名患者中，有 765 名接受了艾滋病毒检测；151 名（19.7%）检测呈阳性，与源人群中的流行率相似。尽管艾滋病毒阳性患者比艾滋病毒阴性患者年轻（p<0.001），但艾滋病毒状况与肿瘤特征无关。37 名妇女（25.9%）的 CD4 细胞计数<200 个/μl。在严重免疫功能低下组的患者比其他组的患者年龄更大（p=0.01）。这项研究是首次在大样本中分析艾滋病毒与乳腺癌之间的关联。根据我们样本中的艾滋病毒流行率和医院服务地区的人口情况，为艾滋病毒流行社区服务的临床医生应该促进对年轻乳腺癌患者进行常规艾滋病毒检测，并在开始化疗之前，对检测呈阳性的患者立即进行治疗。需要研究艾滋病毒和低 CD4 细胞计数对治疗和结果的影响。
