Survival in People Living with HIV with or without Recurrence of Hepatocellular Carcinoma after Invasive Therapy

SIMPLE SUMMARY: Few data are available on HCC outcomes in people living with HIV (PLWH), especially regarding HCC treatment and recurrence. We focused our study on survival and recurCitation: Bertoni, C.; Galli, L.; Lolatto, R.; Hasson, H.; Siribelli, A.; Messina, E.; Castagna, A.; Uberti-Foppa, C.; Morsica, G. rence in HCC/PLWH under invasive therapy by considering also associated factors. To the best of our knowledge, this is the first study investigating survival and recurrence in HCC/HIV people who received invasive therapy, showing that HCC/PLWH under invasive therapy can achieve a good 2- and 5-year survival regardless of HCC recurrence or not. We also showed that the best outcome in terms of survival was obtained in transplanted participants. Our findings, although obtained in a small sample size, suggest that HCC/PLWH should have the same treatment opportunities as HIV-negative participants also in terms of re-treatment. As for the counterpart of HIV-uninfected participants, a more aggressive treatment than what was recommended by the BCLC system could be offered after careful selection to HCC/PLWH. ABSTRACT: Background and Aims: To address the overall survival (OS) and recurrence (RE) in people living with HIV (PLWH) treated with invasive therapy (IT) for hepatocellular carcinoma (HCC). Methods: This is a retrospective cohort study on 41 PLWH with HCC receiving IT, defined as liver resection (LR), orthotopic liver transplantation (OLT), radiofrequency thermo-ablation (RFTA) trans arterial chemo, or radioembolization (CRE). OS and RE were investigated by Kaplan–Meier curves. The Cox proportional hazard regression model was used for multivariate analyses. Results: Recurrence occurred in 46.3% PLWH; in 36.7% of participants at 2 years and in 52% at 5 years from HCC diagnosis; it was less frequent in males, p = 0.036. Overall, 2- and 5-year survival after HCC diagnosis was 72% and 48%, respectively. Two-and five-year survival was 100% and 90.9%, respectively, in PLWH receiving OLT, compared to other IT (60.9% and 30.6%, respectively) log-rank p = 0.0006. Two- and five-year survival in participants with no-RE was 70.5% and 54.6%, respectively, and 73.7% and 42.1% among RE, respectively, log-rank p = 0.7772. By multivariate analysis, AFP at values < 28.8 ng/mL, at HCC diagnosis, was the only factor predicting survival. Conclusions: Fifty percent of PLWH survived five years after HCC diagnosis; 90.9% among OLT patients. Recurrence after IT was observed in 46% of HCC/PLWH. AFP cut-off levels of 28.8 ng/mL were the only independent variable associated with survival.