Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: A U.S.–Canadian multicenter study

• Published in: Journal of hepatology 2007-10, Vol.47 (4), p.527-537
• Main Authors: Bräu, Norbert, Fox, Rena K, Xiao, Peiying, Marks, Kristen, Naqvi, Zeenat, Taylor, Lynn E, Trikha, Anita, Sherman, Morris, Sulkowski, Mark S, Dieterich, Douglas T, Rigsby, Michael O, Wright, Teresa L, Hernandez, Maria D, Jain, Mamta K, Khatri, Gajendra K, Sterling, Richard K, Bonacini, Maurizio, Martyn, Catherine A, Aytaman, Ayse, Llovet, Josep M, Brown, Sheldon T, Bini, Edmund J
• Format: Article
• Language: English
• Subjects: Adult; Canada; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Female; Gastroenterology and Hepatology; Hepatitis B; Hepatitis C; Hepatitis C, Chronic - complications; Hepatocellular Carcinoma; HIV; HIV Infections - complications; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; Neoplasm Staging; Prognosis; Treatment; Treatment Outcome; United States
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2007.06.010

Background/Aims HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC). Methods A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites. Results HIV-positive patients were younger than controls (52 vs. 64 years, p < 0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p < 0.001), were more frequently symptomatic (51% vs. 38%, p = 0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p = 0.005), but a similar mean Child–Turcotte–Pugh score (7.0 vs. 7.5, p = 0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C + D in 50% vs. 58%, p = 0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p = 0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p = 0.017), but median survival was similar (6.9 vs. 7.5 months, p = 0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p < 0.001), any proven therapy (HR, 2.19; p < 0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p = 0.010), Barcelona-Clínic-Liver-Cancer stages C + D (HR, 0.491; p < 0.001), AST/ALT ⩾ 2.00 (HR, 0.597; p = 0.001), AFP ⩾ 400 ng/mL (HR, 0.55, p = 0.003), and platelets ⩾ 100,000/mm3 (HR, 0.651; p = 0.012), but not HIV-serostatus ( p = 0.19). In HIV-infected patients without HCC therapy ( n = 33), median survival was longer with undetectable HIV RNA (