BACKGROUND Breast cancer is the most common malignancy diagnosed among women in South Africa, with the aggressive triple-negative subtype comprising approximately 15% of breast cancers in this population. South Africa has the largest population of people with HIV in the world. This study aims to evaluate the association between HIV status and the proportion of patients with breast cancer with the triple-negative subtype. METHODS We did a cross-sectional analysis of case-only data from the South African Breast Cancer and HIV Outcomes (SABCHO) study, a prospective cohort study recruiting patients with newly diagnosed breast cancer at six public hospitals in South Africa. We analysed data from patients who enrolled in SABCHO between Jan 1, 2015, and Jan 18, 2022. Women aged 18 years or older with newly diagnosed and histologically confirmed invasive breast cancer were eligible. Participants were classified as HIV-positive or HIV-negative by use of an ELISA-based HIV test done at the time of enrolment. We developed multivariable logistic regression models to test for an association between HIV status and the proportion of triple-negative relative to non-triple-negative breast cancers while adjusting for demographic and reproductive risk factors. FINDINGS Of the 4122 patients enrolled in the SABCHO cohort within our study timeframe, 239 patients were excluded due to unknown breast cancer subtype (n=141), HIV status (n=97), or race (n=1). 3883 women with breast cancer were included in the study, of whom 637 (16·4%) had triple-negative breast cancer, 894 (23·0%) were HIV-positive, and 186 (4·8%) had triple-negative breast cancer and HIV. Triple-negative breast cancer accounted for 186 (20·8%) of 894 breast cancers among women who were HIV-positive and 451 (15·1%) of 2989 breast cancers among women who were HIV-negative (p<0·0001). In the fully adjusted logistic regression model, HIV-positive status was associated with an increased proportion of triple-negative breast cancer (adjusted odds ratio [OR] 1·39, 95% CI 1·12-1·74, compared with women who were HIV-negative). When compared with women who were HIV-negative, the association between HIV-positive status and the proportion of triple-negative breast cancer was strongest among the subgroup of women with a duration of HIV infection of 2 years or longer (1·57, 1·23-2·00) and those on antiretroviral therapy (ART; 1·47, 1·16-1·87). INTERPRETATION Patients with breast cancer and chronic HIV who are on ART are more likely to have triple-negative breast cancer than patients with breast cancer without HIV. This association is independent of age, race, and reproductive factors. FUNDING US National Institutes of Health, University of the Witwatersrand, South Africa Medical Research Council Common Epithelial Cancers Research Center, Conquer Cancer Foundation, and Varmus Global Scholars Fund.

中文翻译：

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南非乳腺癌患者 HIV 状态与三阴性乳腺癌的相关性：来自前瞻性队列研究的仅病例数据的横断面分析。


背景 乳腺癌是南非女性中最常见的恶性肿瘤，侵袭性三阴性亚型约占该人群乳腺癌的 15%。南非是世界上 HIV 感染者人数最多的国家。本研究旨在评估 HIV 状态与三阴性亚型乳腺癌患者比例之间的关联。方法 我们对南非乳腺癌和 HIV 结果 （SABCHO） 研究的仅病例数据进行了横断面分析，这是一项前瞻性队列研究，在南非的六家公立医院招募新诊断的乳腺癌患者。我们分析了 2015 年 1 月 1 日至 2022 年 1 月 18 日期间参加 SABCHO 的患者的数据。年满 18 岁且经组织学证实的浸润性乳腺癌女性符合条件。参与者在入组时使用基于 ELISA 的 HIV 检测被归类为 HIV 阳性或 HIV 阴性。我们开发了多变量 logistic 回归模型，以检验 HIV 状态与相对于非三阴性乳腺癌比例之间的关联，同时调整人口统计学和生殖危险因素。结果在我们的研究时间范围内，在 SABCHO 队列中招募的 4122 名患者中，有 239 名患者因乳腺癌亚型 （n=141）、HIV 状态 （n=97） 或种族 （n=1） 而被排除在外。该研究纳入了 3883 名患有乳腺癌的女性，其中 637 名 （16·4%） 患有三阴性乳腺癌，894 名 （23·0%） 患有 HIV 阳性，186 名 （4·8%） 患有三阴性乳腺癌和 HIV。 在 HIV 阳性女性中，3阴性乳腺癌占 186 例 （20·8%），在 HIV 阴性女性中，351 例 （15·1%） 占 2989 例乳腺癌 （p<0·0001）。在完全调整的 logistic 回归模型中，HIV 阳性状态与三阴性乳腺癌比例增加相关（与 HIV 阴性女性相比，校正比值比 [OR] 1·39,95% CI 1·12-1·74）。与 HIV 阴性女性相比，HIV 阳性状态与三阴性乳腺癌比例之间的相关性在 HIV 感染持续时间为 2 年或更长时间的妇女亚组 （1·57， 1·23-2·00） 和接受抗逆转录病毒治疗的女性亚组 （ART; 1·47， 1·16-1·87） 中最强。解释 接受 ART 治疗的乳腺癌和慢性 HIV 患者比没有 HIV 的乳腺癌患者更容易患三阴性乳腺癌。这种关联与年龄、种族和生殖因素无关。资助美国国立卫生研究院、金山大学、南非医学研究委员会常见上皮癌研究中心、征服癌症基金会和 Varmus 全球学者基金会。