The influence of HIV infection on the natural history of hepatocellular carcinoma: results from a global multi-cohort study
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Authors
Pinato, David James
Chen, Ting-Yi
Trevisani, Franco
Minguez, Beatriz
Zoli, Marco
Harris, Marianne
Dalla Pria, Alessia
Merchante, Nicolas
Platt, Heather
Jain, Mamta
Caturelli, Eugenio
Kikuchi, Luciana
Pineda, Juan
Nelson, Mark
Farinati, Fabio
Rapaccini, Gian Ludovico
Aytaman, Asye
Yin, Michael
Tan, Chee-Kiat
Bower, Mark
Giannini, Edoardo G
Bräu, Norbert
Journal Title
Journal of Clinical Oncology
ISSN
1527-7755
Publisher
American Society of Clinical Oncology
Type
Article
This Version
AM
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Pinato, D. J., Allara, E., Chen, T., Trevisani, F., Minguez, B., Zoli, M., Harris, M., et al. (2018). The influence of HIV infection on the natural history of hepatocellular carcinoma: results from a global multi-cohort study. Journal of Clinical Oncology https://doi.org/10.1200/JCO.18.00885
Abstract
Purpose. Conflicting evidence indicates HIV-seropositivity to influence the outcome of patients with hepatocellular carcinoma (HCC), a leading cause of mortality in people with HIV. We aimed to verify whether HIV affected the overall survival (OS) of patients with HCC independent of treatment and geographic origin.
Patients and Methods: We designed an international multi-cohort study of HCC patients who did not receive any anticancer treatment accrued from four continents. We estimated the effect of HIV-seropositivity on patients’ OS while accounting for common prognostic factors and demographic characteristics in uni- and multi-variable models.
Results: A total of 1588 patients were recruited, 132 of whom were HIV-positive. Most patients clustered within Barcelona Clinic Liver Cancer (BCLC) C/D criteria (n=1168, 74%), Child-Turcotte-Pugh (CTP) Class B (median score 7, IQR 3). At HCC diagnosis the majority of HIV-positive patients (n=65, 64%) had been on anti-retrovirals for a median duration of 8.3 years (IQR 8.59) and had median CD4+ cell counts of 256 (IQR 284) with undetectable HIV RNA (n=68, 52%). OS significantly reduced throughout BCLC stages 0-D (16, 12, 7.5, 3.1 and 3 months, p<0.001). Median OS of HIV-positive patients was half that of HIV-uninfected counterparts: 2.2 months, (bootstrap 95%CI 1.2-3.1) versus 4.1 months (95%CI 3.6-4.4). In adjusted analyses HIV-seropositivity increased the hazard of death by 24% (p=0.0333) independent of BCLC (p<0.0001), CTP (p<0.0001), alpha-fetoprotein (AFP) (p<0.0001), geographical origin (p<0.0001) and male gender (p=0.0016). Predictors of worse OS in HIV-positive patients included CTP (p=0.0071) and AFP (p<0.0001).
Conclusions. Despite adequate antiretroviral treatment, HIV-seropositivity is associated with decreased survival in HCC independent of stage, anti-cancer treatment and geographical origin. Mechanistic studies investigating the immuno-biology of HIV-associated HCC are urgently required.
Identifiers
External DOI: https://doi.org/10.1200/JCO.18.00885
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288305
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