Breast Cancer Clinical Characteristics, Management, and Outcomes in Women Living With HIV/AIDS Globally: A Systematic Review and Meta-Analysis

Although associations between HIV and breast cancer (BC) have been investigated, the global literature remains inconsistent regarding clinical features and outcomes in HIV-positive patients. This study aims to clarify the clinicopathologic characteristics, management strategies, and survival in HIV-positive versus HIV-negative patients with BC. We searched PubMed, Scopus, and Cochrane Library for articles published until June 2023. We included observational studies presenting original data on tumor stage, receptor status, management, and survival in HIV-infected patients. We retrieved 5214 records and, after abstract and full-text screening, identified 17 papers that met inclusion criteria. Risk of bias and study quality were assessed with a modified Newcastle-Ottawa Scale. The I² statistic was used to assess inter-study heterogeneity. Results were analyzed using a random-effects model. A total of 1201 HIV-positive and 4077 HIV-negative patients diagnosed with BC were identified. No significant differences in receptor status or stage at presentation were observed between the two groups in our pooled analysis. Management in HIV-positive patients was similar to HIV-negative for surgery (pooled odds ratio [pOR]: 1.43, 95% confidence interval [CI]: 0.82-2.04), radiation (pOR: 1.63, 95% CI 0.84-2.43), and chemotherapy (pOR: 1.27, 95% CI: 0.72-1.83). Despite presenting with similar clinicopathologic characteristics and management patterns as HIV-negative, HIV-positive patients had worse overall survival (pooled hazard ratio: 1.51, 95% CI: 1.21-1.88). Further research is needed to optimize treatment strategies and establish standardized guidelines for HIV-positive patients with BC, particularly in resource-limited settings where a high HIV burden and barriers to timely cancer care access may contribute to poor survival outcomes.