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dc.contributor.authorPinato, David Jamesen
dc.contributor.authorAllara, Eliasen
dc.contributor.authorChen, Ting-Yien
dc.contributor.authorTrevisani, Francoen
dc.contributor.authorMinguez, Beatrizen
dc.contributor.authorZoli, Marcoen
dc.contributor.authorHarris, Marianneen
dc.contributor.authorDalla Pria, Alessiaen
dc.contributor.authorMerchante, Nicolasen
dc.contributor.authorPlatt, Heatheren
dc.contributor.authorJain, Mamtaen
dc.contributor.authorCaturelli, Eugenioen
dc.contributor.authorKikuchi, Lucianaen
dc.contributor.authorPineda, Juanen
dc.contributor.authorNelson, Marken
dc.contributor.authorFarinati, Fabioen
dc.contributor.authorRapaccini, Gian Ludovicoen
dc.contributor.authorAytaman, Asyeen
dc.contributor.authorYin, Michaelen
dc.contributor.authorTan, Chee-Kiaten
dc.contributor.authorBower, Marken
dc.contributor.authorGiannini, Edoardo Gen
dc.contributor.authorBräu, Norberten
dc.date.accessioned2019-01-22T00:31:01Z
dc.date.available2019-01-22T00:31:01Z
dc.identifier.issn1527-7755
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/288305
dc.description.abstractPurpose. 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.
dc.publisherAmerican Society of Clinical Oncology
dc.titleThe influence of HIV infection on the natural history of hepatocellular carcinoma: results from a global multi-cohort studyen
dc.typeArticle
prism.publicationNameJournal of Clinical Oncologyen
dc.identifier.doi10.17863/CAM.35621
dcterms.dateAccepted2018-10-13en
rioxxterms.versionofrecord10.1200/JCO.18.00885en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2018-10-13en
dc.contributor.orcidAllara, Elias [0000-0002-1634-8330]
dc.identifier.eissn1527-7755
rioxxterms.typeJournal Article/Reviewen
cam.issuedOnline2018-12-18en
rioxxterms.freetoread.startdate2019-06-18


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