A. Mokdad1, A. Singal3, J. Mansour1, H. Zhu2, A. Yopp1 1University Of Texas Southwestern Medical Center,Surgical Oncology,Dallas, TX, USA 2University Of Texas Southwestern Medical Center,Medical Oncology,Dallas, TX, USA 3University Of Texas Southwestern Medical Center,Digestive And Liver Diseases,Dallas, TX, USA
Introduction:
Liver-related complications such as hepatocellular carcinoma (HCC) are a major cause of morbidity and mortality in individuals infected with HIV, particularly among those also infected with hepatitis B or hepatitis C viruses. There is a lack of consensus regarding the clinical presentation, treatment, and outcomes in HIV-infected patients with HCC. We compared the clinical presentation, treatment, and survival of patients with HCC, with and without HIV infection.
Methods:
We linked the Texas cancer registry to the HIV/AIDS data for all years between 2001 and 2011. Patient demographics, socioeconomic status, cancer stage, and treatment were compared between patients with HCC and patients with HCC and HIV. Using a standard HIV population, we calculated annual age, sex, and race standardized incidence and all-cause mortality of HCC in patients with and without HIV. We estimated standardized incidence and mortality ratios for the entire study period. We calculated the fraction of mortality related to the following cause-of-death categories: HCC, end-stage liver disease, and HIV. We used a shared frailty model to evaluate risk-adjusted survival in patients with HCC and HIV and with HCC only. We explored the association between HIV infection and treatment of HCC using a mixed-effects logistic regression model.
Results:
18,291 patients with HCC were included in the study; 236 had HIV infection. Compared to patients with HCC only, patients with HCC and HIV were younger at the time of HCC diagnosis (63 years vs. 53 years, p-value < 0.01), male (91.3% vs. 71.9%; p-value < 0.01), African American (41.8% vs. 12.9%; p-value < 0.01), and of lower socioeconomic status (52.6% vs 41.9%; p-value = 0.02). Overall cancer stage and treatment provision were similar. The unadjusted median survival was 6.1 and 6.4 months (log-rank test p-value = 0.38) in the HCC and the HCC and HIV groups, respectively. Age, sex, and race standardized incidence increased and mortality decreased in both groups over the study period. The mean standardized incidence ratio for patients with HCC and HIV was 2.4 ± 0.35; the mean standardized mortality ratio was 2.7 ± 0.36. The most common cause of death was liver cancer, 70 percent and 54 percent, in patients with HCC only and with HCC and HIV, respectively. In the HCC and HIV group, 23 percent died from HIV sequelae. Adjusted survival was worse in patients with concurrent HIV infection (hazard ratio = 1.23, 95% confidence interval: 1.04 – 1.46). After accounting for facility effect, patient demographics, socioeconomic status, and HCC characteristics, there was no difference in provision of resection, ablation procedure, or chemotherapy between both groups.
Conclusion:
Patients with HIV are associated with a higher risk of developing HCC. HCC and concurrent HIV infection is associated with worse survival. It is imperative to improve screening, diagnosis, and management of HCC in patients with HIV.