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HIV infection linked to shorter survival in hepatocellular carcinoma

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February 22, 2019

HIV seropositivity appeared associated with shorter OS among patients with hepatocellular carcinoma despite sufficient antiretroviral treatment, according to results of a global multicohort study published in Journal of Clinical Oncology.

“Although patients with HCC and well-controlled HIV should face no barriers in the provision of active anticancer treatment compared with HIV-negative individuals, the inferior probability of survival that accompanies patients with HIV deserves to be taken into account in patient counseling and therapeutic decision-making,” David J. Pinato, MD, PhD, National Institute for Health Research academic clinical lecturer in medical oncology in the division of surgery and cancer at Imperial College London, and colleagues wrote. “Our study emphasizes the predominance of tumor-related factors and hepatic reserve over parameters relating to the severity of HIV infection in influencing survival.”

Pinato and colleagues analyzed 1,588 patients with HCC who received no prior anticancer treatment.

The cohort included 132 HIV-positive patients (median age, 52.9 years; 94.7% men) and 1,456 HIV-negative patients (median age, 66 years; 81.9% men). The majority of patients (n = 1,168) fell within Barcelona Clinic Liver Cancer stage C or D criteria and Child-Turcotte-Pugh functional class B.

Most of the HIV-positive patients (n = 65) had been on antiretrovirals for median 8.3 years (interquartile range, 8.59 years) and had median CD4-positive cell counts of 256 (IQR, 284) with undetectable HIV RNA (n = 68). They also had a higher prevalence of hepatitis C-related chronic liver disease (78% vs. 37.1%, P = .0001) than HIV-negative patients.

Results showed median OS for the entire cohort of 4 months (95% CI, 3.8-4.1), with significant declines throughout Barcelona Clinic Liver Cancer stages 0 (16 months) to D (3 months).

Researchers reported OS of 2.2 months (95% CI, 1.2-3.1) among HIV-positive patients and 4.1 months (95% CI, 3.6-4.4) among those not infected with HIV.

Adjusted analysis showed HIV seropositivity increased the risk for death by 24% (95% CI, 2-52; P = .0333). Other factors independently associated with OS included male sex (P = .0016) and Barcelona Clinic Liver Cancer stage, Child-Turcotte-Pugh class, -fetoprotein level and geographical origin (all P < .001). Among HIV-positive patients, predictors of worse OS included Child-Turcotte-Pugh class (P = .0071) and -fetoprotein level (P < .0001).

Study limitations included the fact that most of the patients selected had advanced-stage HCC.

“Follow up research should explore the prognostic impact of socioeconomic factors and comorbid conditions, two aspects that might be unevenly distributed across patients who were HIV-positive and HIV-negative and might relate to the difference in survival observed in our study,” Pinato and colleagues wrote. “In parallel, mechanistic studies on clinical samples evaluating the immunopathologic features of HIV-associated HCC in comparison with HIV-negative controls are urgently required.” – by John DeRosier

Disclosures: Pinato reports research funding from Bristol-Myers Squibb and Merck. Please see the study for all other authors’ relevant financial disclosures.

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