title: Hepatocellular carcinoma in HIV-infected patients: check early, treat hard.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era. The aims of this study were to describe HCC tumor characteristics and different therapeutic approaches, to evaluate patient survival time from HCC diagnosis, and to identify clinical prognostic predictors in patients with and without HIV infection.
  
  
  METHODS
  A multicenter observational retrospective comparison of 104 HIV-infected patients and 484 uninfected patients was performed in four Italian centers. HCC was staged according to the Barcelona Clinic Liver Cancer (BCLC) criteria.
  
  
  RESULTS
  Tumor characteristics of patients with and without HIV were significantly different for age, Eastern Cooperative Oncology Group performance status (PS) score ≤1, and etiology of chronic liver disease. Despite the similar potentially curative option rate and better BCLC stage at diagnosis, the median survival time was significantly shorter in HIV(+) patients. HIV(+) patients were less frequently retreated at relapse. Independent predictors of survival were: BCLC stage, potentially effective HCC therapy, tumor dimension ≤3 cm, HCC diagnosis under a screening program, HCC recurrence, and portal vein thrombosis. Restricting the analysis to HIV(+) patients only, all positive prognostic factors were confirmed together with HAART exposure.
  
  
  CONCLUSIONS
  This study confirms a significantly shorter survival time in HIV(+) HCC patients. The less aggressive retreatment at recurrence approach does not balance the benefit of younger age and better BCLC stage and PS score of HIV(+) patients. Thus, considering the prognosis of HIV(+) HCC patients, effective screening techniques, programs, and specific management guidelines are urgently needed.
authors.affiliation: Department of Medical Oncology, National Cancer Institute, Aviano (PN) Italy, Via Franco Gallini 2, 33081 Aviano (PN), Italy. mberretta@cro.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Berretta
authors.forename: Elisa
authors.initials: E
authors.lastname: Garlassi
authors.forename: Bruno
authors.initials: B
authors.lastname: Cacopardo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappellani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Stefania
authors.initials: S
authors.lastname: Cocchi
authors.forename: Paolo
authors.initials: P
authors.lastname: De Paoli
authors.forename: Arben
authors.initials: A
authors.lastname: Lleshi
authors.forename: Immacolata
authors.initials: I
authors.lastname: Izzi
authors.forename: Augusta
authors.initials: A
authors.lastname: Torresin
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Gangi
authors.forename: Antonello
authors.initials: A
authors.lastname: Pietrangelo
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Ferrari
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bearz
authors.forename: Salvatore
authors.initials: S
authors.lastname: Berretta
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Nasti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: Luca
authors.initials: L
authors.lastname: Balestreri
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Ventura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy / Q000821:virology*; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome