Impact of HIV infection on overall survival among women with stage IV breast cancer in South Africa

Yoanna S. Pumpalova, Oluwatosin A. Ayeni, Wenlong Carl Chen, Daniel S. O’Neil, Sarah Nietz, Boitumelo Phakathi, Ines Buccimazza, Sharon Čačala, Laura W. Stopforth, Hayley A. Farrow, Maureen Joffe, Witness Mapanga, Judith S. Jacobson, Katherine D. Crew, Herbert Cubasch, Paul Ruff, Alfred I. Neugut

Research output: Contribution to journalArticlepeer-review


Purpose: Advanced breast cancer (BC) at diagnosis is common in sub-Saharan Africa (SSA), including among women living with HIV (WLWH). In public hospitals across South Africa (SA), 10–15% of women present with stage IV BC, compared to < 5% in the United States (US); 20% of new BC diagnoses in SA are in WLWH. We evaluated the impact of HIV on overall survival (OS) among women with stage IV BC. Methods: We conducted a prospective cohort study of women diagnosed with stage IV BC between February 2, 2015 and September 18, 2019 at six public hospitals in SA. Multivariate Cox regression models were used to estimate the association between HIV status and OS. Results: Among 550 eligible women, 147 (26.7%) were WLWH. Compared to HIV-negative BC patients, WLWH were younger (median age 45 vs. 60 years, p < 0.001), predominantly black (95.9% vs. 77.9%, p < 0.001), and more likely to have hormone receptor-negative (hormone-negative) BC (32.7% vs. 22.6%, p = 0.016). Most women received systemic cancer-directed therapy (80.1%). HIV status was not associated with treatment or OS (Hazard Ratio (HR) 1.13 [95%CI 0.89–1.44]). On exploratory subgroup analysis, WLWH and hormone-negative BC had shorter OS compared to HIV-uninfected women (1-year OS: 27.1% vs. 48.8%, p = 0.003; HR 1.94 [95%CI 1.27–2.94]; p = 0.002), which was not observed for hormone receptor-positive BC. Conclusion: HIV status was not associated with worse OS in women with stage IV BC in SA and cannot account for the poor survival in this cohort. Subgroup analysis revealed that WLWH with hormone-negative BC had worse OS, which warrants further investigation.

Original languageEnglish (US)
Pages (from-to)285-296
Number of pages12
JournalBreast cancer research and treatment
Issue number1
StatePublished - Aug 2021


  • Breast cancer
  • HIV
  • Metastatic
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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