- 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.
- 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.
- 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>
- Most patients had advanced HCC.
- Observational design.