829 
Clinical Presentation and Outcome of Hepatocellular Carcinoma in HIV-infected Patients
M Puoti*1, R Bruno2, V Soriano3, E Vaccher4, F Donato1, G B Gaeta5, G P Quinzan6, D Precone5, C Filice2, F Suter6, G Carosi1, U Tirelli4, and GICAT, Brescia HCC Study Group, CLIP
1Univ. of Brescia, Italy; 2Univ. of Pavia, Italy; 3Inst. de Salud Carlos III, Madrid,Spain; 4CRO, Aviano, Italy; 5SUN, Napoli, Italy; and 6Hosp. Riuniti, Bergamo, Italy
Background:
Hepatocellular carcinoma
(HCC) is an increasing cause of
mortality in HIV+. The aim of the study is to identify clinical
characteristics of HCC in HIV+
persons and to compare them with those observed in anti-HIV- subjects.
Methods:
In this non-concurrent prospective case
control study, we enrolled HIV+
subjects with a diagnosis of HCC defined
according to EASL guidelines notified to 2 registries for tumors. All cases of HCC diagnosed in HIV- subjects in the
town of Brescia
from 1995 to 1998 and all HIV- cases from the registry of the Cancer
of the Liver Italian Project (CLIP) were enrolled as control groups. Data on
each eligible case were collected through a standardized case record form. All
patients were followed up for at least 2 years. Clinical characteristics at
presentation and survival were compared between HIV+ and HIV-
subjects by logistic regression and Cox’s proportional hazard regression
analysis.
Results:
Of the 41 cases of HIV+ subjects
with HCC, 1 received the first
diagnosis in 1989, 2 in 1997, 2 in 1998, 2 in 1999, 6 in the year 2000, and 10
in the first 6 months of the year 2001; 33 cases have been observed in Italy
and 8 in Spain. Their individual data have been compared with those of the 384
HIV- from the Brescia HCC
study group registry and those of the 701 HIV- from the CLIP registry.
Multivariate analysis adjusted for age and gender identified an association
between HIV infection and higher prevalence of HCV infection (OR 11 vs Brescia HCC study group; p = 0.005 and 9 p = 0.006
vs CLIP registry), and higher frequency of infiltrating tumors or extranodal
metastasis at presentation (OR 11,8; p
<0.001 vs Brescia HCC study
group and 17,3 p = 0.001 vs CLIP
registry). These variables were independently associated with HIV infection in
both comparisons. HIV infection was associated with reduced survival
independently from treatment, Child-Pugh status, portal invasion, serum
alfa-fetoprotein, tumor morphology, and size (HR 1,63 p = 0.015 vs Brescia HCC
study group and HR 1,5 p = 0.013 vs
CLIP registry).
Conclusions:
Our data suggest that HCC in HIV+ has a more aggressive
clinical course that reduces the chances for cure. Thus preventive strategies
for HCC should be implemented in
the management of HIV-infected subjects.
Keywords: Hepatocellular Carcinoma; Hepatitis C virus; Survival
