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Liver Int. 2019 Jan;39(1):136-146. doi: 10.1111/liv.13921. Epub 2018 Jul 30.

Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort.

Author information

1
Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.
2
DHU Hepatinov, Villejuif, France.
3
CHU de Guadeloupe, Service d'Hépato-Gastro-Entérologie, Faculté de Médecine Hyacinthe Bastaraud, Université Antilles-Guyane, Guadeloupe, France.
4
Inserm-UMR-S1085/IRSET, Rennes, France.
5
Service de Radiologie, AP-HP Hôpital Paul-Brousse, Villejuif, France.
6
Faculté de Médecine Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
7
Inserm-CESP-UMR1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
8
Service de Médecine Interne, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
9
AP-HP Hôpital Henri Mondor, URC-CEpiA-EA7376, Université Paris Est, Créteil, France.
10
Unité d'Hépatologie, AP-HP Hôpital Cochin, USM20, Institut Pasteur, Université Paris-Descartes, Paris, France.
11
Inserm-UMR1193, Université Paris-Saclay, Villejuif, France.
12
Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Cochin, Université Paris Descartes, Paris, France.
13
Service de Radiologie, AP-HP Hôpital Jean Verdier, Université Paris13, Bondy, France.
14
Service d'Hépato-Gastro-Entérologie, AP-HP Hôpital Jean Verdier, Bondy, France.
15
Bobigny, Inserm-UMR1162, Université Paris13, Paris, France.
16
Service de Santé Publique, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.

Abstract

BACKGROUND & AIMS:

HIV/HCV co-infected patients with hepatocellular carcinoma (HCC) have poorer survival than HCV mono-infected patients. We aimed to evaluate the prognostic factors for survival.

METHODS:

From 2006 to 2013, 55 incident HCCs among HIV+/HCV+ patients, from three ANRS cohorts, were compared with 181 HCCs in HIV-/HCV+ patients from the ANRS Cirvir cohort.

RESULTS:

HIV+/HCV+ patients were younger (50 years [IQR: 47-53] vs 62 [54-70], P < 0.001), male (89% vs 63%, P < 0.001) than HIV-/HCV+ patients. At HCC diagnosis, both groups had a majority of non-responders to anti-HCV-therapy, and HIV+/HCV+ patients had more frequently known a previous cirrhosis decompensation (31% vs 14%, P = 0.005). At diagnostic imaging, there were more infiltrative forms of HCC in HIV+/HCV+ group (24% vs 14%, P < 0.001), associated with tumour portal thrombosis in 29%. During a median follow-up period of 11.96 [5.51-27] months since HCC diagnosis, a majority of palliative treatments were decided in HIV+/HCV+ patients (51% vs 19%, P < 0.001). The 1 and 2-year crude survival rates were 61% versus 78% and 47% versus 63%, P = 0.003 respectively. In a Cox model multivariate analysis adjusted for the cohort, age and sex, the most important prognostic factor for survival was the infiltrative form of the tumour (aRR: 8.10 [4.17-15.75], P < 0.001).

CONCLUSIONS:

The radiological aggressiveness of the tumour is the best prognostic factor associated with poorer survival of HCC in HIV+/HCV+ patients. High α-foetoprotein level and decompensated cirrhosis are other ones. This justifies a particular attention to the detection and the management of small nodules in this high-risk population.

KEYWORDS:

HIV/HCV co-infected patients; hepatocellular carcinoma; prognostic factors; therapeutic strategy

PMID:
29947467
DOI:
10.1111/liv.13921
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