Delayed ART in a HER2+ Breast Cancer Patient with HIV: Clinical Deterioration and Recovery

• Aya Said Allan

  Jordan University Hospital

Patients with HIV who are receiving chemotherapy for breast cancer face a state of immunosuppression that is further exacerbated by the chemotherapy. It has been demonstrated that cases of HER2-positive breast cancer, which require intensive treatment, are particularly vulnerable if antiretroviral therapy (ART) is delayed. A 42-year-old woman with a recent diagnosis of stage IIIB HER2-positive breast cancer and a newly detected HIV infection had antiretroviral therapy (ART) deferred, despite having a CD4 count of 350 cells/mm³. During the course of chemotherapy, the patient's CD4 count decreased to 190 cells/mm³, while her viral load increased to 66,000 copies/mL. The patient exhibited symptoms including neutropenia, oral candidiasis, and bacterial infections. The administration of ART occurred midway through the treatment regimen. Subsequent microbiological diagnostics (VITEK 2 system) revealed the presence of ESBL-producing Klebsiella pneumoniae. The therapeutic approach was adapted in accordance with the patients' susceptibility to the treatment and their respective renal function. The patient's clinical status was stabilized, as evidenced by an increase in CD4 count to 265 cells/mm³ and a decrease in viral load to 7,000 copies/mL. The initiation of antiretroviral therapy (ART) at an early stage, the incorporation of microbiological guidance, and the coordination of care among multiple disciplines are pivotal in enhancing outcomes for HIV-positive patients undergoing cancer therapy.

Altaf, U., Saleem, Z., Akhtar, M., Altowayan, W., Alqasoumi, A., Alshammari, M., Haseeb, A., Raees, F., Imam, M., Batool, N., Akhtar, M., & Godman, B. (2023). Using Culture Sensitivity Reports to Optimize Antimicrobial Therapy: Findings and Implications of Antimicrobial Stewardship Activity in a Hospital in Pakistan. Medicina, 59(7), 1237. https://doi.org/10.3390/medicina59071237

Anamika, F., Chitkara, A., Saharan, K., Choudhary, T., Soni, U., Harmon, G. A., & Saeed, A. (2023). Trastuzumab-induced cardiotoxicity in breast cancer patients: A meta-analysis and review of the literature (2012-2022). Journal of Clinical Oncology, 41(16_suppl), e24101–e24101. https://doi.org/10.1200/JCO.2023.41.16_suppl.e24101

Averbuch, D., Orasch, C., Cordonnier, C., Livermore, D. M., Mikulska, M., Viscoli, C., Gyssens, I. C., Kern, W. V., Klyasova, G., Marchetti, O., Engelhard, D., & Akova, M. (2013). European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica, 98(12), 1826–1835. https://doi.org/10.3324/haematol.2013.091025

Azam, F., Latif, M. F., Farooq, A., Tirmazy, S. H., AlShahrani, S., Bashir, S., & Bukhari, N. (2019). Performance Status Assessment by Using ECOG (Eastern Cooperative Oncology Group) Score for Cancer Patients by Oncology Healthcare Professionals. Case Reports in Oncology, 12(3), 728–736. https://doi.org/10.1159/000503095

Basavaraj, K., Navya, M., & Rashmi, R. (2010). Quality of life in HIV/AIDS. Indian Journal of Sexually Transmitted Diseases and AIDS, 31(2), 75. https://doi.org/10.4103/0253-7184.74971

Baskin, A. S., Huppert, L. A., Kelil, T., Singer, L., & Mukhtar, R. A. (2024). The neoadjuvant approach to treatment of breast cancer: Multidisciplinary management to improve outcomes. Surgical Oncology Insight, 1(2), 100059. https://doi.org/10.1016/j.soi.2024.100059

Bertaglia, V., Morelli, A. M., Solinas, C., Aiello, M. M., Manunta, S., Denaro, N., Tampellini, M., Scartozzi, M., & Novello, S. (2023). Infections in lung cancer patients undergoing immunotherapy and targeted therapy: An overview on the current scenario. Critical Reviews in Oncology/Hematology, 184, 103954. https://doi.org/10.1016/j.critrevonc.2023.103954

Bogdanić, N., Bendig, L., Lukas, D., Zekan, Š., & Begovac, J. (2021). Timeliness of antiretroviral therapy initiation in the era before universal treatment. Scientific Reports, 11(1), 10508. https://doi.org/10.1038/s41598-021-90043-7

Bouwer, N. I., Jager, A., Liesting, C., Kofflard, M. J. M., Brugts, J. J., Kitzen, J. J. E. M., Boersma, E., & Levin, M.-D. (2020). Cardiac monitoring in HER2-positive patients on trastuzumab treatment: A review and implications for clinical practice. The Breast, 52, 33–44. https://doi.org/10.1016/j.breast.2020.04.005

Chasimpha, S., dos Santos Silva, I., Martei, Y. M., Grover, S., Cubasch, H., & McCormack, V. (2023). Survival Disparities Between Patients with Breast Cancer With and Without HIV: A Research Framework. JCO Global Oncology, (9). https://doi.org/10.1200/GO.22.00330

Chirkut, S. (2019). Breast cancer, human immunodeficiency virus and highly active antiretroviral treatment; implications for a high-rate seropositive region. Oncology Reviews, 13(1). https://doi.org/10.4081/oncol.2019.376

Dykstra, M. P., Sadigh, K. S., Nkele, I., Bvochora-Nsingo, M., Martei, Y. M., Wester, J., Manyake, K., Efstathiou, J. A., Vuylsteke, P., Tapela, N. M., & Dryden-Peterson, S. (2024). Quality of Life Gain Following Treatment Among Breast Cancer Survivors With and Without HIV. JCO Global Oncology, (10). https://doi.org/10.1200/GO.24.00110

Esteva, F. J., & Katz, E. (2024). Tailoring Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer: Recent Advances and Strategies. JCO Oncology Practice, 20(8), 1046–1054. https://doi.org/10.1200/OP.23.00563

Guo, L., Ye, L., Zhao, Q., Ma, Y., Yang, J., & Luo, Y. (2014). Comparative study of MALDI-TOF MS and VITEK 2 in bacteria identification. Journal of Thoracic Disease, 6(5), 534–538. https://doi.org/10.3978/j.issn.2072-1439.2014.02.18

Iannuzzi, S., & von Kleist, M. (2021). Mathematical Modelling of the Molecular Mechanisms of Interaction of Tenofovir with Emtricitabine against HIV. Viruses, 13(7), 1354. https://doi.org/10.3390/v13071354

Kemnic, T. R., & Gulick, P. G. (2026). HIV Antiretroviral Therapy.

Maadi, H., Soheilifar, M. H., Choi, W.-S., Moshtaghian, A., & Wang, Z. (2021). Trastuzumab Mechanism of Action; 20 Years of Research to Unravel a Dilemma. Cancers, 13(14), 3540. https://doi.org/10.3390/cancers13143540

Mendicino, C. C. P., Moodie, E. E. M., Guimarães, M. D. C., & Pádua, C. A. M. de. (2021). Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil. Cadernos de Saúde Pública, 37(9). https://doi.org/10.1590/0102-311x00143520

Mercadel, C. J., Skelley, J. W., Kyle, J. A., & Elmore, L. K. (2014). Dolutegravir. Journal of Pharmacy Technology, 30(6), 216–226. https://doi.org/10.1177/8755122514544126

Mohammadi, R., & Foroughifar, E. (2016). Candida infections among neutropenic patients. Caspian Journal of Internal Medicine, 7(2), 71–77.

Mouchemore, K. A., & Anderson, R. L. (2021). Immunomodulatory effects of G-CSF in cancer: Therapeutic implications. Seminars in Immunology, 54, 101512. https://doi.org/10.1016/j.smim.2021.101512

Pimentel, G. S., Ceccato, M. das G. B., Costa, J. de O., Mendes, J. C., Bonolo, P. de F., & Silveira, M. R. (2020). Qualidade de vida em indivíduos iniciando a terapia antirretroviral: um estudo de coorte. Revista de Saúde Pública, 54, 146. https://doi.org/10.11606/s1518-8787.2020054001920

Puerta-Alcalde, P., Ambrosioni, J., Chumbita, M., Hernández-Meneses, M., Garcia-Pouton, N., Cardozo, C., Moreno-García, E., Marco, F., Mensa, J., Rovira, M., Esteve, J., Martínez, J. A., García, F., Mallolas, J., Soriano, A., Miró, J. M., & Garcia-Vidal, C. (2021). Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case–Control Study. Infectious Diseases and Therapy, 10(2), 955–970. https://doi.org/10.1007/s40121-021-00445-3

Rodrigues, A., Struchiner, C. J., Coelho, L. E., Veloso, V. G., Grinsztejn, B., & Luz, P. M. (2021). Late initiation of antiretroviral therapy: inequalities by educational level despite universal access to care and treatment. BMC Public Health, 21(1), 389. https://doi.org/10.1186/s12889-021-10421-8

Sharma, A., Jasrotia, S., & Kumar, A. (2024). Effects of Chemotherapy on the Immune System: Implications for Cancer Treatment and Patient Outcomes. Naunyn-Schmiedeberg’s Archives of Pharmacology, 397(5), 2551–2566. https://doi.org/10.1007/s00210-023-02781-2

Villacampa, G., Matikas, A., Oliveira, M., Prat, A., Pascual, T., & Papakonstantinou, A. (2023). Landscape of neoadjuvant therapy in HER2-positive breast cancer: a systematic review and network meta-analysis. European Journal of Cancer, 190, 112885. https://doi.org/10.1016/j.ejca.2023.03.042

Vo, L., Nguyen, P., Nguyen, H., Phan, D., Vo, X., Vo, L., Nguyen, Y. N., & Huynh, G. (2025). Health-Related Quality of Life Among Patients Living with HIV/AIDS in Vietnam: A Cross-Sectional Study. Patient Preference and Adherence, Volume 19, 1197–1210. https://doi.org/10.2147/PPA.S514101

Welz, T., Wyen, C., & Hensel, M. (2017). Drug Interactions in the Treatment of Malignancy in HIV-Infected Patients. Oncology Research and Treatment, 40(3), 120–127. https://doi.org/10.1159/000458443

Wu, D., & Xiong, L. (2020). Efficacy analysis of trastuzumab, carboplatin and docetaxel in HER 2 positive breast cancer patients. Oncology Letters. https://doi.org/10.3892/ol.2020.11277

Zaher, H. A. El, Fathy, H., Abozeid, M., & Faisal, M. (2023). Neoadjuvant chemotherapy for stage II–III breast cancer: a single-center experience. World Journal of Surgical Oncology, 21(1), 314. https://doi.org/10.1186/s12957-023-03199-z

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