HCC: HIV infection tied to worse OS despite adequate ART

  • Pinato DJ & al.
  • J Clin Oncol
  • 18 Dec 2018

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A global multicohort study of patients with hepatocellular carcinoma (HCC) finds that HIV infection, despite adequate antiretroviral therapy (ART), is associated with 24% increased mortality independent of anticancer treatment, HCC stage, and geographical origin.

Why this matters

  • First study to assess the effect of HIV infection on the natural history of HCC (without anticancer treatment).
  • Worse prognosis with HIV infection suggests aggressive treatment of HCC.

Study design

  • Multicohort study from 4 continents of patients with untreated HCC (n=1588, of whom 132 were HIV-positive).
  • Primary outcome was OS.
  • Funding: National Institute for Health Research; Chelsea and Westminster NHS Foundation Trust Joint Research Committee Research Grant.

Key results

  • 74% of patients had Barcelona Clinic Liver Cancer (BCLC) C or D criteria and liver function reserve by Child-Turcotte-Pugh (CTP) class B (median score, 7).
  • At HCC diagnosis, 51.5% of patients had undetectable HIV viral load and 53.8% had CD4 counts >200 cells/mm.
  • HIV-positive patients with HCC had shorter median OS (2.2 [bootstrap 95% CI, 1.2-3.1] months vs 4.1 [95% CI, 3.6-4.4] months in HIV-negative patients with HCC).
  • After adjustment, HIV-positive patients had 24% increase in mortality (HR, 1.24; P=.0333) independent of BCLC, CTP, α-fetoprotein, geographical origin (all P<.0001 and male sex>

Limitations

  • Most patients had advanced HCC.
  • Observational design.

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