The Impact of HIV on Hepatocellular Cancer Survival in Nigeria.

BACKGROUND Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV-infected individuals. We compared host and tumor characteristics between HIV-infected and uninfected Nigerians with HCC and examined the impact of HIV on survival. METHODS This prospective observational study was conducted at Jos University Teaching Hospital in Jos, Nigeria among adults (>18yrs) with HCC enrolled between September 2015 and September 2017 and followed until April 2019. Demographics, tumor characteristics, and survival were compared between HCC subjects with and without HIV. RESULTS 101 subjects (10 HIV-infected and 91 HIV-uninfected) were enrolled [male 72%; median age 48 (IQR 35-60)]. 60% HIV-infected subjects were receiving ART; 90% had CD4 counts ≥ 200/mm3 at HCC diagnosis and 20% had HIV RNA levels < 20 copies/mL. 57.4% were infected with chronic HBV (HBsAg+). The duration of symptoms was shorter in HIV-infected vs. uninfected subjects [93 (IQR 54-132) vs. 155 (93-248] days; p=0.02]. At the end of follow-up, 99/101 (98.0%) subjects were confirmed to have died: 9/10 (90.0%) HIV-infected and 90/91 (98.9%) HIV-uninfected. The probability of survival at three months was 22% and 47% in HIV-infected and HIV-uninfected subjects, respectively (p=0.02). Median time to death was significantly shorter in HIV-infected vs. HIV-uninfected subjects [24 days (IQR 16-88) vs. 85 days (IQR 34-178), respectively (p=0.03)]. CONCLUSIONS High early mortality was observed in this cohort of Nigerian adults with HCC. HIV infection was associated with a faster clinical presentation and shorter survival. More aggressive HCC surveillance may be warranted in HIV-infected subjects, particularly if they are co-infected with chronic HBV.