TY - JOUR
T1 - Presentation and outcome of hepatocellular carcinoma in HIV-infected patients
T2 - A U.S.-Canadian multicenter study
AU - Bräu, Norbert
AU - Fox, Rena K.
AU - Xiao, Peiying
AU - Marks, Kristen
AU - Naqvi, Zeenat
AU - Taylor, Lynn E.
AU - Trikha, Anita
AU - Sherman, Morris
AU - Sulkowski, Mark S.
AU - Dieterich, Douglas T.
AU - Rigsby, Michael O.
AU - Wright, Teresa L.
AU - Hernandez, Maria D.
AU - Jain, Mamta K.
AU - Khatri, Gajendra K.
AU - Sterling, Richard K.
AU - Bonacini, Maurizio
AU - Martyn, Catherine A.
AU - Aytaman, Ayse
AU - Llovet, Josep M.
AU - Brown, Sheldon T.
AU - Bini, Edmund J.
PY - 2007/10
Y1 - 2007/10
N2 - Background/Aims: HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC). Methods: A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites. Results: HIV-positive patients were younger than controls (52 vs. 64 years, p < 0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p < 0.001), were more frequently symptomatic (51% vs. 38%, p = 0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p = 0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p = 0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C + D in 50% vs. 58%, p = 0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p = 0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p = 0.017), but median survival was similar (6.9 vs. 7.5 months, p = 0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p < 0.001), any proven therapy (HR, 2.19; p < 0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p = 0.010), Barcelona-Clínic-Liver-Cancer stages C + D (HR, 0.491; p < 0.001), AST/ALT ≥ 2.00 (HR, 0.597; p = 0.001), AFP ≥ 400 ng/mL (HR, 0.55, p = 0.003), and platelets ≥ 100,000/mm3 (HR, 0.651; p = 0.012), but not HIV-serostatus (p = 0.19). In HIV-infected patients without HCC therapy (n = 33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p = 0.013). Conclusions: HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.
AB - Background/Aims: HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC). Methods: A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites. Results: HIV-positive patients were younger than controls (52 vs. 64 years, p < 0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p < 0.001), were more frequently symptomatic (51% vs. 38%, p = 0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p = 0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p = 0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C + D in 50% vs. 58%, p = 0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p = 0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p = 0.017), but median survival was similar (6.9 vs. 7.5 months, p = 0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p < 0.001), any proven therapy (HR, 2.19; p < 0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p = 0.010), Barcelona-Clínic-Liver-Cancer stages C + D (HR, 0.491; p < 0.001), AST/ALT ≥ 2.00 (HR, 0.597; p = 0.001), AFP ≥ 400 ng/mL (HR, 0.55, p = 0.003), and platelets ≥ 100,000/mm3 (HR, 0.651; p = 0.012), but not HIV-serostatus (p = 0.19). In HIV-infected patients without HCC therapy (n = 33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p = 0.013). Conclusions: HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.
KW - HIV
KW - Hepatitis B
KW - Hepatitis C
KW - Hepatocellular Carcinoma
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=34548331766&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2007.06.010
DO - 10.1016/j.jhep.2007.06.010
M3 - Article
C2 - 17692986
AN - SCOPUS:34548331766
SN - 0168-8278
VL - 47
SP - 527
EP - 537
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 4
ER -