HIV Increases Mortality Risk in Patients With Hepatocellular Carcinoma

HIV significantly increases the risk of death in patients with hepatocellular carcinoma (HCC), according to a new study. The findings add clarity and precision to a question that has in the past been muddled with contradictory study outcomes.

“The reason why we wanted to conduct this study really is that there has been a lot of contention over whether or not HIV determines the prognosis of patients with HCC,” said corresponding author David J. Pinato, MD, PhD, of Imperial College London.

In an effort to bring more certainty to the question, Pinato and colleagues devised a large-scale, multi-center study involving 1588 patients across 4 continents, including 132 HIV-positive patients. Of the HIV-positive patients, 64% had been on antiretroviral therapy, for a median of 8.3 years. They had median CD4 cell counts of 256, and 52% had undetectable HIV RNA.

Pinato and colleagues found HIV-positive patients with HCC had an adjusted 24% increased hazard of death compared to their HIV-negative peers. That increased risk held true independent of cancer stage, anticancer treatment, or geographic location.

The finding is significant not only because of the size of the risk, but also because it comes at a time when HIV-positive patients with other forms of cancer are generally surviving at similar rates as HIV-negative patients.

HCC is by far the most common type of liver cancer, accounting for 85-90% of all primary liver cancer cases, according to the National Organization for Rare Diseases. In the United States, the prevalence of the disease has increased significantly over the past 40 years, and, according to a 2013 study in the Journal of Clinical Gastroenterology, the 5-year survival rate for HCC is less than 12%.

Pinato said he hopes the study makes clear that HCC in patients with HIV is an urgent healthcare topic.

Pinato said there could be a number of reasons for the heightened mortality rates among HCC patients with HIV, including the possibility that HIV is somehow preconditioning the anticancer immune system. The current study was not designed to answer the question of “Why?”, but Pinato said he and his colleagues are continuing their research in hopes of finding an answer.

Though there is much more research to be done, Pinato said physicians should take notice.

“At the moment, I think our study might suggest that patients with HIV-positive HCC should be regarded as at a high risk of mortality,” he said. “And therefore, I think they should be treated in a multidisciplinary way—even more so than patients with HIV-negative HCC are normally treated.”

More broadly, Pinato said he believes HCC does not get enough attention within the scientific and medical communities. He’s hoping the findings from his study help to shed more light and prompt more research.

“Certainly, from a research point of view as well as a guidelines and treatment point of view there has to be more emphasis on this often-neglected patient population,” he said.

The study, “Influence of HIV Infection on the Natural History of Hepatocellular Carcinoma: Results From a Global Multicohort Study,” was published in the Journal of Clinical Oncology.

This article was originally published by MD Magazine.