HIV
Negative Individuals with Hepatitis C and HIV-HCV Coinfected Patients Have Similar
Hepatocellular Carcinoma Outcomes By
Liz Highleyman Prior
research indicates that HIV-HCV
coinfected individuals -- especially those with advanced immune suppression
-- tend to experience more rapid liver disease progression that HIV negative people
with chronic hepatitis C virus (HCV) infection alone. Outcomes
related to hepatocellular
carcinoma (HCC), however, may not differ significantly between HIV
positive and HIV negative patients with chronic hepatitis C, according to
research presented at the 44th Annual Meeting of the European
Association for the Study of the Liver (EASL 2009) last month in Copenhagen.
M.C.
Cantarini and colleagues from Italy looked at prognosis of HIV positive patients
with HCC, which, they noted, has become an important cause of illness and death
in this population since the advent of HAART.
The
investigators analyzed 28 HIV positive individuals (27 of them men) with chronic
liver disease who were diagnosed with HCC
between 1998 and 2007. These patients were matched 1-to-1 with 28 HIV negative
individuals of the same sex who were diagnosed with HCC at the same hospital between
1995 and 2005. Participants in the 2 groups were matched as closely as possible
for age, grade of liver dysfunction (Child-Pugh class), cancer stage (according
to the BCLC system), and cause of liver disease (in most cases hepatitis C).
The
HIV positive patients were slightly but significantly
younger than the HIV negative group (median 46 vs 50 years). Most (90%) were receiving
antiretroviral therapy; 68%
had undetectable HIV viral load and the median CD4 count was about 300 cells/mm3,
indicating moderate immune dysfunction.
Rates and duration of survival
in the 2 groups and independent prognostic predictors were assessed.
Results
Overall, 32% of study participants had Child-Pugh Class A disease, 34% had Class
B, and 25% had Class C.
Nearly half (46%) had early BCLC stage HCC, 21% had intermediate-stage cancer,
7% had advanced HCC, and 25% had end-stage disease.
These distributions did not differ significantly between the HIV positive and
HIV negative groups.
Type of HCC treatment did not differ between the 2 groups.
89% pf HIV positive patients and 85% of HIV negative patients underwent "curative
or effective" therapy.
The median duration of survival was the same in both groups, at 16 months (range
3-29 months).
Causes of death did not differ between the 2 groups.
In a multivariate analysis, BCLC stage and HCC treatment were independent prognostic
factors for the entire study population and for the HIV positive group.
Based
on these findings, the investigators concluded, "The survival of HIV positive
patients with chronic liver disease and HCC is similar to that of HIV negative
patients and is determined by liver function, cancer bulk, and cancer treatment."
Dipartimento
di Malattie dell'Apparato Digerente e Medicina Interna, University of Bologna,
Bologna, Italy.
5/29/09 Reference
MC
Cantarini, G Verucchi, P Costigliola, and others. Outcome of Hepatocellular Carcinoma
in HIV-Infected Patients with Chronic Liver Disease: a Comparison with HIV Negative
Controls. 44th Annual Meeting of the European Association for the Study of the
Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.
EASL
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