Demographics, Clinical Presentation, and Outcomes of HIV Infected and Uninfected Patients with Hepatocellular Carcinoma

With highly active antiretroviral therapy (HAART), HIV infected individuals have seen longer survival, which is associated with increased mortality and morbidity from chronic liver diseases (CLD). Patients with HIV are 7 times more likely to develop HCC. To date, the clinical course and outcomes of patients with HIV and HCC is not well defined. We compared the survival of HCC patients with and without HIV infection, and we expected demographic factors, clinical presentation, and treatment patterns to impact survival differently between the two groups. We performed a retrospective cohort study of HCC patients at two hospitals within the same system in Dallas between January 2010 and June 2022. We excluded patients without a known HIV diagnosis status. Demographics, prognostic measures, tumor characteristics, treatment modalities, and survival were compared between patients with and without HIV infection. Survival curves were generated using Kaplan- Meier plots and compared with the log rank test. Of the 1,391 patients with HCC, 43 (3.1%) were HIV infected. HIV infected patients were more likely to have Medicare (51% vs 29%; P=0.012) and less likely to be uninsured (0% vs 9.9%; P=0.012). CLD etiologies differed between the groups with HIV infected patients less likely to have alcohol-related liver disease (4.7% vs 17.6%; P<0.001) and more likely to have HBV infection (32.6% vs 5.1%, P<0.001). There were no significant differences in the prognostic measures and tumor characteristics between the two groups. Median overall survival (OS) was similar between HIV infected and uninfected patients (17.2 months vs 21.1 months; P=.318). Median OS was also compared between controlled and poorly controlled HIV infected patients and found to be similar (19.2 months vs 16.0 months; P=.521). On multivariable analysis, factors associated with worse OS included underlying fatty liver disease (HR 1.533, 95% CI 1.1-2.1) and HBV (HR 1.703, 95% CI 1.2-2.5). ECOG functional status>=2 (HR 1.331, 95% CI 1.0-1.7), Child Pugh class B (HR 1.278, 95% CI 1.1-1.5), and having multiple lesions at time of diagnosis (HR 1.213, 95% CI 1.1-1.4) were also associated with worse survival. HIV infection was not independently associated with worse survival (HR 1.295, 95% CI .858-1.955). The relationship between HIV infection and HCC in affecting clinical outcomes remains complex. HIV infected patients present with different underlying liver disease but similar prognostic and tumor characteristics. Overall survival was ultimately found to be similar between HIV infected and uninfected patients with HCC.