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Impact of HIV on the survival of hepatocellular carcinoma in hepatitis C virus-infected patients

AuthorsMerchante, Nicolás; Rodríguez-Fernández, Miguel; Figueruela, Blanca; Rodríguez-Arrondo, Francisco; Revollo, Boris; Ibarra, Sofía; Téllez, Francisco; Merino, Esperanza; Montero-Alonso, Marta; Galindo, María José; Rivero, Antonio; Santos, Ignacio de Lo; Delgado-Fernández, Marcial; García-Deltoro, Miguel; Vera-Méndez, Francisco Jesús; García, María A.; Aguirrebengoa, Koldo; Portu, Joseba; Ríos-Villegas, María José; Villalobos, Marina; Alemán-Valls, María R.; Mínguez, Carlos; Galera, Carlos; Macias, Juan; Pineda, Juan A.
Hepatitis C virus
Hepatocellular carcinoma
Liver cancer
Issue Date1-Aug-2020
PublisherLippincott Williams & Wilkins
CitationAIDS 34(10): 1497-1507 (2020)
Abstract[Background]: Previous studies have suggested that hepatocellular carcinoma (HCC) has an aggressive presentation and a shorter survival in people with HIV (PWH). This could be due to later diagnosis or lower rates of HCC treatment, and not to HIV infection itself.
[Aim]: To assess the impact of HIV on HCC survival in hepatitis C virus (HCV)-infected patients.
[Methods]: Multicenter cohort study (1999–2018) of 342 and 135 HCC cases diagnosed in HIV/HCV-infected and HCV-monoinfected patients. Survival after HCC diagnosis and its predictors were assessed.
[Results]: HCC was at Barcelona-Clinic Liver-Cancer (BCLC) stage 0/A in 114 (33%) HIV/HCV-coinfected and in 76 (56%) HCV-monoinfected individuals (P < 0.001). Of them, 97 (85%) and 50 (68%) underwent curative therapies (P = 0.001). After a median (Q1–Q3) follow-up of 11 (3–31) months, 334 (70%) patients died. Overall 1 and 3-year survival was 50 and 31% in PWH and 69 and 34% in those without HIV (P = 0.16). Among those diagnosed at BCLC stage 0/A, 1 and 3-year survival was 94 and 66% in PWH whereas it was 90 and 54% in HIV-negative patients (P = 0.006). Independent predictors of mortality were age, BCLC stage and α-fetoprotein levels. HIV infection was not independently associated with mortality [adjusted hazard ratio (AHR) 1.57; 95% confidence interval: 0.88–2.78; P = 0.12].
[Conclusion]: HIV coinfection has no impact on the survival after the diagnosis of HCC in HCV-infected patients. Although overall mortality is higher in HIV/HCV-coinfected patients, this seem to be related with lower rates of early diagnosis HCC in HIV-infected patients and not with HIV infection itself or a lower access to HCC therapy.
Publisher version (URL)http://dx.doi.org/10.1097/QAD.0000000000002578
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