Standardized Care Management Ensures Similar Survival Rates in HIV-Positive and HIV-Negative Patients With Hepatocellular Carcinoma

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 1:2 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.