Editor’s Note:
After the HIV virus enters the human body, it first destroys the immune system, leading to a rapid decline in immunity. Consequently, the body becomes more susceptible to various infections and complications, the most common of which are infections in different systems and malignant tumors. As the life expectancy of people living with HIV (PLWH) increases, cases of coexisting malignant tumors are also on the rise. From September 7-9, 2023, the seventeenth International Liver Cancer Association (ILCA) annual meeting (ILCA 2023) was grandly held in Amsterdam, the capital of the Netherlands. At this conference, Dr. Eleonora Alimenti from the University of Pavia, Italy, orally presented the clinical features, treatment status, and clinical outcomes of PLWH coexisting with HCC at Lombardy’s Third Hospital in Italy (Conference Abstract: O-07), drawing significant attention.
Hepatocellular carcinoma (HCC) ranks as the fifth most common cancer globally and the fourth leading cause of cancer-related deaths. Men have a higher risk of developing HCC than women. Among men, it’s the fourth most common cancer and the second leading cause of cancer-related deaths. Hence, the impact of coexisting HCC in PLWH on antitumor treatment and clinical outcomes remains to be clarified.
In this study, researchers aimed to compare the clinical characteristics and outcomes of PLWH treated for HCC at Lombardy’s Third Hospital in Italy with those of non-HIV-infected patients. The study included patients diagnosed with HCC between June 1, 2006, and April 15, 2022, and analyzed the clinical features, treatment methods, and survival rates of PLWH with HCC through a retrospective study. They also compared the clinical features and survival rates of HCC patients, both HIV-infected and non-infected, by calculating propensity scores (PS) to offset potential imbalances in baseline features between the two groups and the correlation between HIV status, CD4 count, and survival rates.
The study included 529 confirmed HCC patients, of which 65 were PLWH coexisting with HCC. Their median age was 54 (ranging from 44-73) years, 92% were male, 63% tested positive for HCV, 73% were at Child-Pugh grade A, the median MELD score was 10 (ranging from 6-26), 68% had no esophagogastric varices, the median CD4+ count was 405 (ranging from 44-1701) cells/mL, and 12.5% had previously been diagnosed with AIDS with a median lowest CD4+ count of 164.5 (ranging from 11-750) cells/mL. The other 464 patients were non-HIV infected with a median age of 68 (ranging from 33-89) years, 75% were male, 77% were at Child-Pugh grade A, the median MELD score was 9 (ranging from 6-33), and 64% had no esophagogastric varices.
Among the PLWH group, 55% had single HCC nodules with a median tumor size of 2.5 (ranging from 1.0-6.3) cm, and 57% met the Milan criteria. BCLC staging was 55% at 0/A, 13% at B, 21% at C, and 11% at D. 31 patients (50%) received first-line HCC treatment.
For the non-HIV infected group, 57% had single HCC nodules with a median size of 2.6 (ranging from 0.5-18) cm, and 66% met the Milan criteria. BCLC staging was 68% at 0/A, 17% at B, 14% at C, and 1% at D. 284 patients (61%) received first-line treatment (see Table 1).
Table 1. Comparison of clinical features and treatment status between HCC patients with and without HIV infection.
The median follow-up period for the PLWH group was 47 (ranging from 0.2-175) months, while for the non-HIV infected group, it was 30 (ranging from 0.5-199) months. The 5-year overall survival rate for the PLWH group was 58%, compared to 56% for the non-HIV infected group (P=0.61).
In summary, the study indicates that compared to non-HIV-infected patients, PLWH coexisting with HCC are more commonly male, younger, and exhibit poorer liver function and more advanced HCC staging (P < 0.05). However, PLWH and non-HIV infected patients showed similarities in receiving first-line HCC treatment and clinical outcomes.
Reference: Eleonora Alimenti, Bianca Monti, Francesco Peracchi, et al. Hepatocellular carcinoma in HIV-infected patients: Clinical presentation and outcomes. ILCA 2023 Abstract O-07.
TAG: ILCA 2023, Commentary, HCC
