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

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.
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Moana Gelu-Simeon, Maïté Lewin, Maria Ostos, Tatiana Bayan, Maria Beso Delgado, et al.. Prognostic factors of survival in HIV/HCV co-infected patients with hepatocellular carcinoma The CARCINOVIC Cohort. Liver International, Wiley-Blackwell, In press, 39 (1), pp.136-146. ⟨10.1111/liv.13921⟩. ⟨hal-01874554⟩

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