Breast cancer and human immunodeficiency virus infection: issues for the 21st century

As we enter the 21st century, AIDS and breast cancer are two pressing issues in women's health. The spread of AIDS continues unabated. More than 21.8 million people have died of AIDS, and it is estimated that as of December 2000 an additional 36.1 million people, mostly in sub-Saharan Africa, were infected with the human immunodeficiency virus. In addition, women now constitute almost one half of all AIDS cases. With the widespread use of highly active antiretroviral therapy in the United States, the overall health and survival of HIV(+) individuals has improved dramatically. Thus, as the HIV(+) population matures, we will be called on to diagnose and treat more cases of breast cancer in seropositive women. What can we expect as the incidence of these two diseases begins to overlap? Medline search, and review of the relevant literature. Forty-six published cases of breast cancer in HIV(+) individuals identified. Based on epidemiologic data from Western countries and Africa, HIV infection is not permissive for breast cancer. This is reflected in the paucity of available data. Early reports consisted of case reports, describing advanced cancers with unusual presentations and uniformly poor prognoses. Recent series describe more favorable prognoses and long-term survivors. It appears that hormonal therapy is well tolerated and effective, even in cases of locally advanced disease, and the toxicity from standard chemotherapy regimens is unacceptably high.