Improved survival of hepatocellular carcinoma (HCC) in HIV-infected patients with undetectable HIV RNA
Presented by Emma Page (United Kingdom).
E. Page1, M.E. Vispo2, D. Kaplan3,4, L. Kikuchi5, M. Núñez6, M. Nelson1, P. Barreiro2, J. Daruich7, K. Marks8, R. Fox9, M. Sherman10, M. Puoti11, N. Brau12,13, Liver Cancer in HIV Study Group
1Chelsea & Westminster Hospital, London, United Kingdom, 2Hospital Carlos III, Madrid, Spain, 3Philadelphia Veterans Affairs Medical Center, Philadelphia, United States, 4University of Pennsylvania, Philadelphia, United States, 5Universidade de São Paulo, São Paulo, Brazil, 6Wake Forest University, Winston-Salem, United States, 7Universidad de Buenos Aires, Buenos Aires, Argentina, 8Weill Cornell Medical College, New York, United States, 9University of California at San Francisco, San Francisco, United States, 10University of Toronto, Toronto, ON, Canada, 11Università degli Studi di Brescia, Brescia, Italy, 12Bronx Veterans Affairs Medical Center, Bronx, United States, 13Mount Sinai School of Medicine, New York, United States
Background: High HIV-RNA plasma levels in HIV/HCV-coinfected patients are associated with faster hepatic fibrosis progression, and HIV/HCV patients with undetectable HIV-RNA have a similar fibrosis progression rate as HCV-monoinfected subjects. It is unknown if HIV-RNA concentrations also affects other aspects of liver disease. This study examines the influence of this parameter on outcome of HCC.
Methods: HIV-infected patients with HCC were retrospectively identified from 1992-2009 in 22 centers in North and South America and Europe. Each HCC diagnosis was confirmed using the 2005 AASLD criteria.
Results: Among 117 HIV-infected patients with HCC, 115 had results of HIV-RNA testing available at time of HCC diagnosis and are analyzed here. Plasma HIV-RNA was undetectable (< 400 copies/mL) in 68 patients (58%). Compared to the 47 patients with any level of detectable HIV-RNA (>400 copies/mL), they were similar in age (mean 51 years), sex (92% male), etiology of HCC (HCV 74%; HBV 24%), and alcohol consumption (excessive in 39%). However, patients with HCV-RNA < 400 copies/mL tended to present less frequently with symptoms (38% vs. 55%, p=0.070) and presented with a lower Child-Turcotte-Pugh score (6.4 vs. 7.3, p=0.007) and a lower Cancer-of-the-Liver-Italian-Program (CLIP) staging score (1.7 vs. 2.4, p=0.004). The Barcelona-Clínic-Liver-Cancer (BCLC) stages, however, were similar (advanced stages C+D in 47% vs. 53%, p=0.52). The HIV RNA undetectable group also had better median overall survival (11.7 vs. 4.9 months, p=0.007, log rank). This survival benefit was only seen in untreated patients (6.4 vs. 2.5 months, p=0.005), but not in patients with any effective HCC therapy (12.7 vs. 9.3 months, p=0.74).
Conclusion: In HIV-infected patients with HCC, undetectable HIV-RNA at the time of diagnosis is associated with better survival. However, this phenomenon is only observed in patients receiving no HCC therapy. Any effective HCC therapy obliterates the beneficial effect of suppressed HIV infection on survival.
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