Cardiovascular risk factors and cardiac dysfunction in people with HIV and breast cancer: an observational cohort study in Botswana

TL;DR

This study examines cardiovascular risks and heart function in HIV-positive women with breast cancer in Botswana, finding a modest decline in heart function after cancer treatment.

Contribution

The study provides new insights into cardiovascular risk and cardiac function in HIV-positive individuals with breast cancer in a low-resource setting.

Findings

Obesity and hypertension are highly prevalent in HIV-positive women with breast cancer.

A statistically significant, but modest decline in left ventricular ejection fraction was observed after cancer treatment.

No clinical heart failure was reported despite the decline in heart function.

Abstract

HIV, cancer, and their respective treatments are independently associated with cardiovascular risk, but limited data exist on the intersection of these conditions. The purpose of this study was to gain insights into the cardiovascular risk factor burden and cardiac function in people with HIV (PWH) treated for breast cancer.

In a cohort of PWH and breast cancer treated with anthracyclines and/or trastuzumab (2017–2022) in Botswana, we assessed pre-treatment (baseline) left ventricular ejection fraction (LVEF), and prospectively obtained an echocardiogram at least one year after cancer treatment initiation. Wilcoxon signed rank sum test was used to test the differences between baseline and follow-up LVEF.

Thirty-three women were enrolled at a median of 2.1 years (Quartile (Q)1-Q3 1.8–3.1) from their cancer treatment initiation. The median age was 48.0 years (Q1-Q3 44.0–54.0). All but one patient was on antiretroviral therapy (ART); the median ART duration was 11.6 years (Q1-Q3 6.3–15 years) with a median viral load of 30 (Q1-Q3 0–30) and CD4 count of 874 (Q1-Q3 361–1131). At baseline, 70% were obese or overweight, and 24.2% reported hypertension; this increased to 30.3% at follow-up. The median LVEF at baseline was 65% (Q1-Q3 60–68%), and decreased to 62% (Q1-Q3 59–65%) at follow-up; an absolute difference of 2.9%, 95%CI: -5.3 to -0.2% (p = 0.038). There was no report of clinical heart failure.

Obesity and hypertension are highly prevalent amongst PWH and breast cancer. We also noted a statistically significant, but modest decline in LVEF after cancer therapy initiation. Further studies are needed to prospectively characterize the cardiovascular risk factor burden and changes in cardiac structure and function following cardiotoxic cancer treatment in this population.

The online version contains supplementary material available at 10.1186/s40959-025-00417-3.

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