Standardized care management ensures similar survival rates in HIV-positive and HIV-negative patients with hepatocellular carcinoma.

ABSTRACT

OBJECTIVE: It has been suggested that HIV infection has a detrimental impact on patients with hepatocellular carcinoma (HCC). The present study sought to test this hypothesis, while controlling for tumor extension and liver disease. DESIGN AND SETTING: A case control and a cohort approach were performed in patients with HCC managed prospectively via dedicated multidisciplinary team meeting in a single tertiary institution between 2004 and 2009. SUBJECTS: Of 473 consecutive treatment-naive patients with HCC, 23 were HIV-positive (HIV) and 450 were HIV-negative (HIV). HIV patients were matched 12 with a control group of HIV patients in terms of the etiology of HCC, the severity of liver disease, tumor extension, and year of diagnosis. INTERVENTION Curative or palliative treatment of HCC. MAIN OUTCOME MEASURES: Eligibility for HCC treatment, the treatment actually administered, and the survival rate. RESULTS: The HIV population was younger than the HIV population (mean age 49 vs. 61 years, respectively; P < 0.0001). Curative treatment was recommended by the multidisciplinary team meeting and then actually performed to a similar extent in HIV patients (74% and 43%, respectively) and their matched HIV controls (74% and 56%, respectively). The HIV and their matched HIV patients did not differ significantly in terms of the 3-year survival rate [44% vs. 48%, respectively; mean (95% confidence interval) hazard ratio = 0.64 (0.3-1.3); P = 0.2]. In a cohort analysis, HIV status was not an independent predictor of survival among curatively treated patients. CONCLUSION: In an equal-access unbiased environment, HIV status does not significantly influence treatment access, delivery, and outcome.