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.