Patients with hepatocellular carcinoma and HIV had better-preserved liver function and presented with earlier-stage cancer but had similar survival rates to those without HIV in a recent study.
In a retrospective cohort study, researchers evaluated 190 patients with cirrhosis and hepatocellular carcinoma (HCC) at a single hospital between January 2005 and December 2010. The cohort included 26 patients with HIV infection and 164 noninfected participants.
Patients with HIV presented with compensated liver disease more frequently than noninfected patients (62% vs. 32%; P=.01), and also had early-stage tumors more often (39% compared with 17%; P=.04 for Barcelona Clinic Liver Cancer stage A). Solitary tumors were more common among HIV-infected patients (65% of patients compared with 40%; P=.02), as were smaller tumors (median 2.6 cm compared with 4.6; P=.02) than in noninfected patients. Patients with HIV also had higher levels of serum alpha-fetoprotein (median 325 ng/mL vs. 95 ng/mL; P<.01).
Median overall survival times were similar between patients with HIV and noninfected patients (9.6 months compared with 5.2 months; P=.85). Curative treatment was administered more often to HIV-infected participants (27% compared with 6% among noninfected patients; P=.01). Overall survival was associated with patients aged 60 years or younger (HR=1.7; P=.01), Child-Turcotte-Pugh-class A (HR=1.6; P<.01), receipt of curative treatment (HR=2.9; P<.01) and absence of symptoms on presentation (HR=2.1; P<.01), but not HIV serostatus, via multivariate analysis.
“Our series demonstrates that HCC patients who are HIV-infected have a similar outcome as HIV-uninfected patients, despite presenting at an earlier tumor stage, having more preserved liver function and undergoing higher rates of curative treatment,” the researchers concluded. “The vast majority of HCC patients, regardless of HIV serostatus, present with advanced stage disease and lack curative treatment options. These findings should be considered in implementing HCC surveillance programs in high-risk patients, including those with HIV infection.”