Navigating the Nexus: HIV and Breast Cancer-A Critical Review

Abstract

Despite significant advances in the management of antiretroviral therapy (ART), leading to improved life expectancy for people living with HIV (PLWH), the incidence of non-AIDS-defining cancers, including breast cancer, has emerged as a critical concern. This review synthesizes current evidence on the epidemiology of breast cancer among HIV-infected individuals, highlighting the potential for an altered risk profile, earlier onset, and more advanced disease at diagnosis. It delves into the molecular considerations underpinning the relationship between HIV and breast cancer, including the role of immunosuppression, chronic inflammation, and gene expression alterations. Additionally, it examines the complexities of managing breast cancer in the context of HIV, particularly the challenges posed by ART and anticancer agents' cross-toxicities and drug-drug interactions. The review also addresses survival disparities, underscoring the need for improved cancer care in this population. By identifying gaps in knowledge and areas requiring further research, this review aims to illuminate the complexities of HIV-associated breast cancer, fostering a deeper understanding of its epidemiology, molecular basis, and clinical management challenges, thereby contributing to better outcomes for individuals at the intersection of these two conditions. This narrative review systematically explores the intersection of HIV infection and breast cancer, focusing on the impact of HIV on breast cancer risk, outcomes, and treatment challenges.

Keywords: AIDS; HIV; breast cancer; drug–drug interactions; non-AIDS defining cancers.

Figure 1

Breast cancer incidence in PLWH compared to people without HIV. Each bar represents a different cohort study’s standard incidence ratios (SIRs) or odds ratios (ORs) for breast cancer incidence in people with HIV. The dashed line at x = 1 represents the baseline risk for the general population.

Figure 2

Interplay between HIV and breast cancer. Impaired immune systems, chronic inflammation, and altered gene expression play a key role in breast cancer development in PLWH, whereas access to care could make a difference in diagnosis and clinical management.

Figure 3

Drug–drug interactions between ART and cytotoxic agents according to Medscape, Liverpool University, and PEPID interaction checkers’ reports. Legend: no interaction expected (green); potential weak interaction (yellow); potential interaction (orange); do not co-administer (red). ANTRA: anthracyclines; CTX: cyclophosphamide; ERI: eribulin; GEM: gemcitabine; MTX: methotrexate; PT: platinum salts; TXN: taxanes; VNB: vinorelbine; 5FU: 5-fluorouracil; NNRTIs: non-nucleoside reverse transcriptase inhibitors; NRTIs: nucleoside reverse transcriptase inhibitors; PIs: protease inhibitors; ABC: abacavir; ABT: albuvirtide; ATV: atazanavir; AZT: zidovudine; BIC: bictegravir; CAB: cabotegravir; c: cobicistat; DPV: dapivirine; DRV: darunavir; DOR: doravirine; DTG: dolutegravir; EFV: efavirenz; ENF: enfuvirtide; EVG: elvitegravir; ETR: etravirine; FTC: emtricitabine; FTR: fostemsavir; IBA: ibalizumab-uiyk; MVC: maraviroc; NVP: nevirapine; RAL: raltegravir; RPV: rilpivirine; RTV/r: ritonavir; TAF: tenofovir alafenamide; TDF: tenofovir-disoproxil fumarate; 3TC: lamivudine.

Figure 4

Drug–drug interactions between ART and biological anticancer agents according to Medscape, Liverpool University, and PEPID interaction checkers’ reports. Legend: no interaction expected (green); potential weak interaction (yellow); potential interaction (orange); do not co-administer (red); unknown interactions (grey). ADCs: antibody drug conjugates; CDK4/6i: cyclin-dependent kinase 4/6 inhibitors; PARPi: poly(ADP) ribose polymerase inhibitors; SG: sacituzumab govitecan; T-DM1: trastuzumab emtansine; T-Dxd: trastuzumab deruxtecan; NNRTIs: non-nucleoside reverse transcriptase inhibitors; NRTIs: nucleoside reverse transcriptase inhibitors; PIs: protease inhibitors; ABC: abacavir; ABT: albuvirtide; ATV: atazanavir; AZT: zidovudine; BIC: bictegravir; CAB: cabotegravir; c: cobicistat; DPV: dapivirine; DRV: darunavir; DOR: doravirine; DTG: dolutegravir; EFV: efavirenz; ENF: enfuvirtide; EVG: elvitegravir; ETR: etravirine; FTC: emtricitabine; FTR: fostemsavir; IBA: ibalizumab-uiyk; MVC: maraviroc; NVP: nevirapine; RAL: raltegravir; RPV: rilpivirine; RTV/r: ritonavir; TAF: tenofovir alafenamide; TDF: tenofovir-disoproxil fumarate; 3TC: lamivudine.