Survival disparities between patients with breast cancer with and without HIV at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH).

Abstract

1622 Background: Breast cancer and HIV/AIDS pose significant public health challenges. Women living with HIV face higher mortality rates when diagnosed with breast cancer than HIV-negative women. Although advancements in treatment have improved survival outcomes, limited evidence exists on the impact of HIV on breast cancer outcomes in low-resource settings. This study examines survival disparities between breast cancer patients with and without HIV. Methods: We conducted a retrospective cohort study of breast cancer patients diagnosed at JOOTRH between January 2013 and September 2024. Data from paper-based records included demographics, clinical data and outcomes (survival status). Survival, defined as time from diagnosis to death or last follow-up, accounted for transfer out, death, being alive, or lost to follow-up. Variables with >20% missingness were excluded. Survival disparities by HIV status were estimated using Kaplan-Meier, with mortality relationships analyzed via Cox Proportional Hazards Model. Results: Out of 494 breast cancer patients, 101(20%) were HIV+, 219 (44%) had unknown HIV status, and 174(36%) were HIV-. At diagnosis, HIV+ patients were younger (median: 48, [IQR 40–56]) compared to HIV- patients (median: 51, [IQR 40–64], p=0.030) and had a lower median BMI (23.2 vs. 25.4, p=0.008). HIV positive patients had a longer median time to treatment initiation (56 days, IQR 25–127) compared to HIV-negative patients (44 days, IQR 20–94), although the difference was not statistically significant (p=0.4). In this cohort, 12% (60) of patients had died, with a higher mortality rate among HIV+ patients (17%, 17 out of 101) compared to HIV- patients (14%, 24 out of 174), while loss to follow-up was substantial in both groups (43% HIV+ vs. 37% HIV-, p<0.001). The crude 5-year survival probability was 14% lower in HIV+ patients (59%, [95% CI 38 – 91]) than HIV- patients (73%, [61–87]). Survival, adjusted for age, smoking, employment, and cancer stage, did not vary significantly by HIV status (HR for HIV+ vs. HIV-: 1.13, 95% CI: 0.51–2.50, p = 0.8). However, survival was significantly lower among patients with health insurance (HR = 0.35, 95% CI: 0.12–0.97, p = 0.044) and those with > primary/elementary school education (HR: 0.13, 95% CI: 0.02, 0.88, p = 0.037) compared to those with primary education only. Patients who did not receive treatment had a significantly higher mortality risk (HR = 3.52, 95% CI: 1.54–8.04, p = 0.003. Conclusions: In this study, breast cancer patients living with HIV had poorer crude 5-year survival probabilities compared to their HIV-negative counterparts, although the adjusted survival did not differ significantly by HIV status. Factors associated with significantly lower survival included lack of treatment, lower education levels, and absence of treatment. These findings underscore the need for targeted interventions to improve breast cancer outcomes among HIV-positive patients, particularly in low-resource settings.