title: Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: a U.S.-Canadian multicenter study.
abstract: OBJECTIVE
  HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites.
  
  
  RESULTS
  HIV-positive patients were younger than controls (52 vs. 64 years, p<0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p<0.001), were more frequently symptomatic (51% vs. 38%, p=0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p=0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p=0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C+D in 50% vs. 58%, p=0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p=0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p=0.017), but median survival was similar (6.9 vs. 7.5 months, p=0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p<0.001), any proven therapy (HR, 2.19; p<0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p=0.010), Barcelona-Clínic-Liver-Cancer stages C+D (HR, 0.491; p<0.001), AST/ALT >or= 2.00 (HR, 0.597; p=0.001), AFP >or= 400 ng/mL (HR, 0.55, p=0.003), and platelets >or= 100,000/mm3 (HR, 0.651; p=0.012), but not HIV-serostatus (p=0.19). In HIV-infected patients without HCC therapy (n=33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p=0.013).
  
  
  CONCLUSIONS
  HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.
authors: Bronx Veterans Affairs (VA) Medical Center, Infectious Disease Section (111F), 130 West Kingsbridge Road, Bronx, NY 10468, USA. norbert.brau@va.gov
authors: Norbert
authors: N
authors: Bräu
authors: Rena K
authors: RK
authors: Fox
authors: Peiying
authors: P
authors: Xiao
authors: Kristen
authors: K
authors: Marks
authors: Zeenat
authors: Z
authors: Naqvi
authors: Lynn E
authors: LE
authors: Taylor
authors: Anita
authors: A
authors: Trikha
authors: Morris
authors: M
authors: Sherman
authors: Mark S
authors: MS
authors: Sulkowski
authors: Douglas T
authors: DT
authors: Dieterich
authors: Michael O
authors: MO
authors: Rigsby
authors: Teresa L
authors: TL
authors: Wright
authors: Maria D
authors: MD
authors: Hernandez
authors: Mamta K
authors: MK
authors: Jain
authors: Gajendra K
authors: GK
authors: Khatri
authors: Richard K
authors: RK
authors: Sterling
authors: Maurizio
authors: M
authors: Bonacini
authors: Catherine A
authors: CA
authors: Martyn
authors: Ayse
authors: A
authors: Aytaman
authors: Josep M
authors: JM
authors: Llovet
authors: Sheldon T
authors: ST
authors: Brown
authors: Edmund J
authors: EJ
authors: Bini
mesh_terms: D000328:Adult; D002170:Canada; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States