The Association of HIV and Other Risk Factors with Triple Negative Breast Cancer in South African Women
Name: Jacob Dubner
School: Vagelos College of Physicians and Surgeons, Class of 2025, Varmus Global Scholar 2022
Mentor: Yoanna Pumpalova, MD and Alfred Neuget, MD
Abstract
Breast cancer mortality in South Africa is more than double that of the United States. A contributing factor to high breast cancer mortality in South Africa is that triple negative breast cancer (TNBC)—the most lethal subtype of breast cancer—makes up a higher percentage of breast cancer cases in black South African women than it does in other parts of the world. South Africa is estimated to have the second highest adult HIV prevalence in the world, but if and how the presence of HIV affects the risk of developing TNBC is not fully understood. This project utilized data from the South African Breast Cancer HIV Outcomes (SABCHO) study to assess whether HIV is associated with increased risk of TNBC relative to other breast cancer subtypes among South African women. Multivariate logistic regression models were constructed to test for associations between HIV and TNBC while adjusting for key demographic and reproductive risk factors. HIV positive status was found to be associated with an increased risk of TNBC relative to non-TNBC [OR: 1.39; 95% CI: 1.11-1.73]. However, measures of HIV control including HIV viral load, CD4+ count, ART status, and ART duration were not associated with TNBC. This suggests that women living with HIV (WLHIV) have an increased risk of developing TNBC, regardless of their how well-controlled their HIV is. Based on this finding, breast cancer screening guidelines should be re-evaluated to promote earlier, more frequent, and more thorough screening of WLHIV to help detect TNBC in its earliest stages.