Standardized Care Management Ensures Similar Survival Rates in HIV-Positive and HIV-Negative Patients With Hepatocellular Carcinoma

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Abstract

Objective:

It has been suggested that HIV infection has a detrimental impact on patients with hepatocellular carcinoma (HCC). The present study sought to test this hypothesis, while controlling for tumor extension and liver disease.

Design and Setting:

A case control and a cohort approach were performed in patients with HCC managed prospectively via dedicated multidisciplinary team meeting in a single tertiary institution between 2004 and 2009.

Subjects:

Of 473 consecutive treatment-naive patients with HCC, 23 were HIV-positive (HIV+) and 450 were HIV-negative (HIV−). HIV+ patients were matched 1:2 with a control group of HIV− patients in terms of the etiology of HCC, the severity of liver disease, tumor extension, and year of diagnosis.

Intervention:

Curative or palliative treatment of HCC.

Main Outcome Measures:

Eligibility for HCC treatment, the treatment actually administered, and the survival rate.

Results:

The HIV+ population was younger than the HIV− population (mean age: 49 vs. 61 years, respectively; P < 0.0001). Curative treatment was recommended by the multidisciplinary team meeting and then actually performed to a similar extent in HIV+ patients (74% and 43%, respectively) and their matched HIV− controls (74% and 56%, respectively). The HIV+ and their matched HIV− patients did not differ significantly in terms of the 3-year survival rate [44% vs. 48%, respectively; mean (95% confidence interval) hazard ratio = 0.64 (0.3–1.3); P = 0.2]. In a cohort analysis, HIV status was not an independent predictor of survival among curatively treated patients.

Conclusion:

In an equal-access unbiased environment, HIV status does not significantly influence treatment access, delivery, and outcome.

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