Presentation, treatment, and clinical outcomes of patients with hepatocellular carcinoma, with and without human immunodeficiency virus infection

Abstract

Background & aims: Liver-related complications such as hepatocellular carcinoma (HCC) are a major cause of morbidity and mortality in individuals infected with human immunodeficiency virus (HIV), particularly among those also infected with hepatitis B or hepatitis C viruses. There is a lack of consensus regarding the clinical presentation, treatment options, and outcomes in HIV-infected patients with HCC. We compared the clinical presentation, treatment, and survival of patients with HCC, with and without HIV infection.

Methods: We conducted a retrospective cohort study of cirrhotic patients diagnosed with HCC at a large safety-net hospital between January 2005 and December 2010. Patients without known HIV serologic status were excluded. Demographic features, tumor characteristics, treatment regimens, and survival were compared between patients (n = 26) with and without HIV infection (n = 164). Survival curves were generated by using Kaplan-Meier plots and compared by using the log-rank test.

Results: A higher percentage of HIV-infected patients presented with compensated liver disease (Child-Turcotte-Pugh stage A) than those without HIV infection (62% vs 32%, respectively; P = .01), as well as those with early-stage tumors (Barcelona Clinic Liver Cancer stage A, 39% vs 17%, respectively; P = .04 and Okuda stage I, 50% vs 21%, respectively; P < .01). HIV-infected patients were more likely to be cured of HCC than uninfected patients (27% vs 4%, respectively; P = .01), but median overall survival times were similar between groups (9.6 vs 5.2 months, respectively; P = .85). The 1-year rates of survival for HIV-infected and uninfected patients were 40% and 38%, respectively.

Conclusions: HIV-infected patients present with earlier-stage HCC and more preserved liver function than uninfected patients, resulting in more curative treatment options. Despite this difference, overall survival was similar between patients with HCC with and without HIV infection.