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

Merchante, Nicolás; Rodríguez-Fernández, Miguel; Figueruela, Blanca; Rodríguez-Arrondo, Francisco; Revollo, Boris; Ibarra, Sofía; Téllez, Francisco; Merino, Esperanza; Montero-Alonso, Marta; Galindo, Marı́a José; Rivero‐Juárez, Antonio; Santos, Ignacio; Delgado-Fernández, Marcial; García-Deltoro, Miguel; Vera-Méndez, Francisco Jesús; García, M.Á. Bonillo; Aguirrebengoa, Koldo; Portu, Joseba; Ríos‐Villegas, Maria José; Villalobos, Marina; Alemán-Valls, María Remedios; Mínguez, Carlos; Galera, Carlos; Macı́as, Juan; Pineda, Juan A.

doi:10.1097/qad.0000000000002578

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…Our data adds to a growing number of studies reporting an adverse effect of HIV on HCC outcomes, several of which have reported similarly reduced survival among PLH and an independent effect of HIV on mortality [14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The mechanisms underlying the effects of…”

Section: Discussionmentioning

confidence: 56%

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Davwar

Okeke²,

Duguru³

et al. 2023

PLoS ONE

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Introduction Hepatocellular carcinoma (HCC) is an increasing cause of mortality in Nigeria among persons with HIV (PLH), as access to antiretroviral therapy (ART) improves. In this study we describe clinical, radiological, and laboratory characteristics in Nigerian adults with HCC, with and without HIV, and examine how HIV impacts survival. Methods This prospective observational study was conducted between August 2018 and November 2021 at two Nigerian hospitals [Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH)]. Subjects ≥18 years with HCC diagnosed according to American Association for the Study of Liver Diseases (AASLD) criteria were included. Baseline characteristics were compared, and Kaplan-Meier curves were generated to estimate survival. Results 213 subjects [177 (83%) without HIV and 36 (17%) with HIV (PLH)] were enrolled. Median age was 52 years (IQR 42,60) and most subjects were male (71%). 83% PLH were on antiretroviral therapy (ART). Hepatitis B surface antigen (HBsAg) positivity was similar between the two groups [91/177 (51%) without HIV vs. 18/36 (50%) with HIV; p = 0.86]. 46/213 (22%) subjects had active hepatitis C (anti-HCV+/HCV RNA>10 IU/mL). Cirrhosis was more common in PLH but there were no other significant differences in clinical and tumor characteristics between the groups. Overall, 99% subjects were symptomatic and 78% in late-stage HCC. Median overall survival was significantly shorter in PLH vs. without HIV (0.98 months vs 3.02 months, HR = 1.55, 95%CI 1.02, 2.37, p = 0.04). This association was not significant after adjusting for known risk factors including gender, current alcohol use, alpha-fetoprotein (AFP), albumin, and total bilirubin (HR = 1.38, 95%CI 0.84, 2.29, p = 0.21). Conclusion HCC presented late with an extremely poor overall prognosis, highlighting the urgent need for more intensive surveillance in Nigeria to diagnose HCC at earlier stages. Early diagnosis and management of viral hepatitis, and access to HCC therapies, could prevent early mortality among persons with HCC, especially among PLH.

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Section: Discussionmentioning

confidence: 56%

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Davwar

Okeke²,

Duguru³

et al. 2023

PLoS ONE

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“…In the study by Merchante et al, [ 26 ] 1- and 3-year survival was 50% and 31% in PLWH and 69% and 34% in those without HIV ( P = 0.16) with 33% of HIV-infected patients showing BCLC = 0/A vs. 56% of HIV uninfected. In our group of PLWH, we found a higher cumulative probability of survival at one year (68%) with a similar prevalence of BCLC = 0/A (34%).…”

Section: Discussionmentioning

confidence: 99%

Levels of Alpha-Fetoprotein and Association with Mortality in Hepatocellular Carcinoma of HIV-1-Infected Patients

Morsica¹,

Galli²,

Messina³

et al. 2022

Journal of Oncology

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Background and Aim. The clinical course of hepatocellular carcinoma (HCC) is determined by cancer-related and nonrelated factors. We evaluated the effect of a cancer-related factor, alpha-fetoprotein (AFP) levels, on mortality in HIV-1-infected patients with HCC. Methods. This is a retrospective cohort study on patients living with HIV-1 infection (PLWH) followed at the Division of Infectious Diseases of the San Raffaele Hospital, with cirrhosis and HCC diagnosed between 1999 and 2018 and with an available AFP value at HCC diagnosis. The area under the receiver operating characteristic curve (AUC) was used to estimate the accuracy of baseline AFP in predicting death. Factors associated with the risk of death were identified using multivariable Cox proportional-hazards regression models. Results. Overall, 53 PLWH were evaluated: 18 patients received a curative treatment (9 liver transplantation, 5 liver resections and 4 radiofrequency ablation) and 35 a noncurative treatment (17 chemo or radio embolization, 10 sorafenib and 8 best supportive care). Baseline AFP was predictive of death [AUC 0.71, 95% confidence interval (CI) 0.54–0.83], and the optimal cut-off was 28.8 ng/mL. At multivariable analysis, BL AFP ≥28.8 ng/mL was associated with death [adjusted hazard ratio (aHR) 7.05, 95% CI 1.94–25.71 P = 0.003]. Other factors were HBV infection (aHR 8.57, 95% CI 1.47–50.08, P = 0.017) and treatment allocation (curative vs. noncurative, aHR 0.08, 95% CI 0.02–0.40, P = 0.0004). Conclusions. Our findings suggest that in PLWH AFP serum levels ≥28.8 ng/mL, HBV coinfection and treatment allocation represent predictive markers for death at the time of HCC diagnosis.

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“…Concerning survival, clinical studies have demonstrated that HCC/PLWH can obtain a satisfactory survival rate after treatment [ 6 , 8 , 49 ]. Although 18 (43.9%) PLWH received non-curative IT (chemo/radioembolization) as their first therapy, we had a good overall survival because approximately 50% of our participants were alive after 5 years from their HCC diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Survival in People Living with HIV with or without Recurrence of Hepatocellular Carcinoma after Invasive Therapy

Bertoni

Galli

Lolatto

et al. 2023

Cancers

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Background and Aims: To address the overall survival (OS) and recurrence (RE) in people living with HIV (PLWH) treated with invasive therapy (IT) for hepatocellular carcinoma (HCC). Methods: This is a retrospective cohort study on 41 PLWH with HCC receiving IT, defined as liver resection (LR), orthotopic liver transplantation (OLT), radiofrequency thermo-ablation (RFTA) trans arterial chemo, or radioembolization (CRE). OS and RE were investigated by Kaplan–Meier curves. The Cox proportional hazard regression model was used for multivariate analyses. Results: Recurrence occurred in 46.3% PLWH; in 36.7% of participants at 2 years and in 52% at 5 years from HCC diagnosis; it was less frequent in males, p = 0.036. Overall, 2- and 5-year survival after HCC diagnosis was 72% and 48%, respectively. Two-and five-year survival was 100% and 90.9%, respectively, in PLWH receiving OLT, compared to other IT (60.9% and 30.6%, respectively) log-rank p = 0.0006. Two- and five-year survival in participants with no-RE was 70.5% and 54.6%, respectively, and 73.7% and 42.1% among RE, respectively, log-rank p = 0.7772. By multivariate analysis, AFP at values < 28.8 ng/mL, at HCC diagnosis, was the only factor predicting survival. Conclusions: Fifty percent of PLWH survived five years after HCC diagnosis; 90.9% among OLT patients. Recurrence after IT was observed in 46% of HCC/PLWH. AFP cut-off levels of 28.8 ng/mL were the only independent variable associated with survival.

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

Cited by 6 publications

References 29 publications

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

Levels of Alpha-Fetoprotein and Association with Mortality in Hepatocellular Carcinoma of HIV-1-Infected Patients

Survival in People Living with HIV with or without Recurrence of Hepatocellular Carcinoma after Invasive Therapy

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