Presentation and Outcome of Hepatocellular Carcinoma in HIV Patients

By Liz Highleyman

As HIV positive individuals live longer thanks to effective antiretroviral therapy, chronic illnesses, including liver disease, have become an increasingly important cause of morbidity and mortality.

Due to overlapping transmission routes, approximately one-third of people with HIV are coinfected with hepatitis C virus (HCV) and many have been exposed to hepatitis B virus (HBV). Liver cirrhosis and hepatocellular carcinoma (a form of liver cancer) are potential serious outcomes of chronic hepatitis B or C. Past research has shown that HIV-HCV coinfected patients tend to experience more rapid liver disease progression, although this may not be the case among individuals with well preserved immune function and high CD4 cell counts.

As reported in the October 2007 Journal of Hepatology, Norbert Brau and colleagues conducted a retrospective analysis of patients at 6 centers between 1992 and 2005. A total of 63 cases of HCC in HIV positive individuals were identified. A group of 226 consecutive HIV negative HCC patients served as controls subjects.

Results

• On average, compared with the HIV negative control subjects with liver cancer, the HIV positive patients with HCC:

o        were younger (52 vs 64 years; P < 0.001);

o        were more likely to be coinfected with chronic hepatitis B or C (97% vs 73%; P < 0.001);

o        were more likely to be symptomatic (51% vs 38%; P = 0.048);

o        had a higher median alfa-fetoprotein (AFP) level, a blood marker for HCC (227 vs 51 ng/ml; P = 0.005);

o        had similar mean Child-Turcotte-Pugh scores (7.0 vs 7.5; P = 0.05) and HCC staging scores (50% vs 58% with Barcelona Clinic Liver Cancer [BCLC] stages C and D; P = 0.24).

• HCC developed faster in HIV-HCV coinfected compared with HCV monoinfected individuals (mean 26 vs 34years after HCV infection; P = 0.002).

• HIV positive patients received proven HCC therapy more often than HIV negative subjects (48% vs 31%; P = 0.017).

• Nevertheless, the HIV positive and HIV negative groups had similar median survival times (6.9 vs 7.5 months; P = 0.44).

• Factors that Independently predicted longer survival were:

o        symptomatic presentation (hazard ratio [HR] 0.437; P < 0.001);

o        any proven therapy (HR 2.19; P < 0.001);

o        diagnosis after January 1, 2002 (HR 1.52; P = 0.010);

o        BCLC stages C and D (HR 0.491; P < 0.001);

o        AST/ALT of 2.00 (HR 0.597; P = 0.001);

o        AFP of 400 ng/mL (HR 0.55; P = 0.003);

o        platelet count of 100,000 cells/mm³ (HR 0.651; P = 0.012).

• HIV serostatus, however, did not independently predict survival (P = 0.19).

• Among the 33 HIV positive patients who did not receive HCC therapy, median survival was longer in those with HIV viral loads below 400 copies/mL compared to those higher HIV RNA levels (6.5 vs 2.6 months; P = 0.013).

Conclusion

“HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients,” the authors concluded. “Tumor staging and survival are similar.”

They added that, “In untreated patients, undetectable HIV RNA independently predicts better survival.”

10/16/07

References

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