Hepatocellular carcinoma in HIV-infected patients: epidemiological features, clinical presentation and outcome.
OBJECTIVE
Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-seropositive individuals. The aim of the study was to compare the main features of HCC in HIV-seropositive individuals with those in to HIV-negative patients.


METHODS
All HIV-infected subjects with a diagnosis of HCC included in three cancer registry databases were enrolled in the study as cases. HCC cases that occurred in the province of Brescia, North Italy, in the period 1995-1998 and all cases reported at the Italian Liver Cancer Project were enrolled as controls. All data were collected using a standardized case report form. The main clinical and epidemiological characteristics of patients with HCC and their survival were compared between HIV-positive and uninfected subjects.


RESULTS
Forty-one HIV-infected subjects with HCC were identified. Multivariate analysis adjusted for age and sex identified an association between HIV infection and HCV infection [odds ratio (OR), 11; P = 0.005], and infiltrating tumours and/or extranodal metastasis at presentation (OR = 11.8; P < 0.001). HIV infection was independently associated with shorter survival (hazard ratio, 1.63; P = 0.015).


CONCLUSIONS
HCC in HIV-infected patients is mainly associated with underlying chronic hepatitis C and has a more aggressive clinical course. Thus, preventative strategies (including the treatment of hepatitis C) should be implemented in the management of HIV/HCV-coinfected patients.
Puoti
Massimo
M
FClinica di Malattie Infettive, Università degli Studi di Brescia-AO Spedali Civili, Brescia, Clinica di Malattie Infettive e Tropicali, Madrid, Spain. m.puoti@iol.it
Bruno
Raffaele
R
Soriano
Vincent
V
Donato
Francesco
F
Gaeta
Giovanni Battista
GB
Quinzan
Gian Paolo
GP
Precone
Davide
D
Gelatti
Umberto
U
Asensi
Victor
V
Vaccher
Emanuela
E
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis