Differences in pathology, staging, and treatment between HIV⁺ and uninfected patients with microscopically confirmed hepatocellular carcinoma

Background: The incidence of hepatocellular carcinoma (HCC) is substantially higher among HIV-infected (HIV⁺) than uninfected persons. It remains unclear if HCC in the setting of HIV infection is morphologically distinct or more aggressive. Methods: We evaluated differences in tumor pathology in a cohort of HIV⁺ and uninfected patients with microscopically confirmed HCC in the Veterans Aging Cohort Study from 2000 to 2015. We reviewed pathology reports and medical records to determine Barcelona Clinic Liver Cancer stage (BCLC), HCC treatment, and survival by HIV status. Multivariable Cox regression was used to determine the hazard ratio [HR; 95% confidence interval (CI)] of death associated with HIV infection after microscopic confirmation. Results: Among 873 patients with HCC (399 HIV⁺), 140 HIV⁺ and 178 uninfected persons underwent liver tissue sampling and had microscopically confirmed HCC. There were no differences in his-tologic features of the tumor between HIV⁺ and uninfected patients, including tumor differentiation (well differentiated, 19% vs. 28%, P = 0.16) and lymphovascular invasion (6% vs. 7%, P = 0.17) or presence of advanced hepatic fibrosis (40% vs. 39%, P = 0.90). There were no differences in BCLC stage (P = 0.06) or treatment (P = 0.29) by HIV status. After adjustment for risk factors, risk of death was higher among HIV-infected than uninfected patients (HR = 1.37; 95% CI, 1.02–1.85). Conclusions: We found no differences in HCC tumor characteristics or background hepatic parenchyma by HIV status, yet HIV was associated with poorer survival. Of note, pathology reports often omitted these characteristics. Impact: Systematic evaluation of HCC pathology by HIV status is needed to understand tumor characteristics associated with improved survival.