title: The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study.
abstract: BACKGROUND
  Breast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly.
  
  
  OBJECTIVE
  The aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups.
  
  
  METHODS
  The study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009-2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically.
  
  
  RESULTS
  One hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and -noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16).
  
  
  CONCLUSIONS
  These results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.
authors: Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
authors: Boitumelo P
authors: BP
authors: Phakathi
authors: Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
authors: Gerhard
authors: G
authors: Basson
authors: Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa. Electronic address: otto.karusseit@up.ac.za.
authors: Victor O L
authors: VOL
authors: Karusseit
authors: Biostatistics Unit, South African Medical Research Council, South Africa.
authors: Steve A S
authors: SAS
authors: Olorunju
authors: Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
authors: Taole
authors: T
authors: Mokoena
mesh_terms: D000328:Adult; D000368:Aged; D024221:Antineoplastic Protocols; D001943:Breast Neoplasms / Q000628:therapy* / Q000821:virology; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D000069451:Long Term Adverse Effects / Q000821:virology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D013019:South Africa
keywords: Breast cancer management; Effect of HIV infection