The strongest survival prognostic factor in people diagnosed with hepatocellular carcinoma (HCC) who are co-infected HIV and hepatitis C virus (HIV+/HCV+) is radiological aggressiveness of the tumor, according to research published in Liver International.
By combining 3 cohorts from the French National Agency for Research on AIDS and Viral Hepatitis, study authors created 1 large group that allowed them to identify 55 participants who had been diagnosed with HCC between 2006 and 2013. They were also able to make comparisons with 181 cases of HCC developed in people who were HIV negative but HCV+ (HIV-/HCV+). All study participants had cirrhosis. Study authors reviewed treatment, assessments, and follow-ups every 3 months until death, loss to follow-up, or liver transplantation.
The researchers analyzed survival rates using Kaplan-Meier curves. They also reviewed data on therapeutic management, prognostic factors related to survival, and causes of death. The survival parameters they evaluated included age when diagnosed with HCC, viral loads, gender, tumor type, alcohol and tobacco use, diabetes status, α-fetoprotein level, and presence of venous portal thrombosis.
Study results revealed significance along a few factors. Being male and younger was significantly associated with HIV+/HCV+ when compared with HCV mono-infections (male: 89% vs 63%, P<.001; median age: 50 years [interquartile range: 47 to 53] vs 62 [54 to 70], P <.001).
Based on results of vascular imaging, study authors found infiltrative HCC in 24% of patients who were HIV+/HCV+ and 14% of patients who were HIV-/HCV+ (P <.001); this association was also a predictive factor for death (adjusted RR of 8.10 [4.17 to 15.75], P <.001).”
Study authors note that “particular attention should be given to HIV+/HCV+ cirrhotic patients because of the specific radiological aggressiveness of the tumor, and specifically high rate of infiltrative forms.”
Gelu-Simeon M, Lewin M, Ostos M, et al; for the ANRS HC EP 25 PRETHEVIC, ANRS CO13 HEPAVIH, and ANRS CO12 CIRVIR study groups. Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: the CARCINOVIC Cohort [published online June 27, 2018]. Liver Int. doi: 10.1111/liv.13921