Comparative Analysis of Presentation and Outcome After Liver Resection of Patients With Hepatocellular Carcinoma With and Without HIV

Objective: Evidence shows that HIV infection may affect the survival outcome of patients with hepatocellular carcinoma (HCC). In this article, we aimed to determine whether HIV affected the overall survival of patients with HCC in China and ascertain the risk factors. Design: Retrospective cohort study. Methods: Participants were enrolled from a single medical center in Guangzhou, China. Survival was assessed using Kaplan-Meier plots and compared using the log-rank test. A multivariable Cox regression analysis was used to assess the effect of HIV seropositivity on patient overall survival while accounting for common prognostic factors. Results: The Kaplan-Meier plots showed that the median survival time of patients who were HIV-positive was 18 months shorter than that of their HIV-negative counterparts (P = 0.00, log rank). The 1- and 3-year rates of survival for HIV-positive patients were 65.4% and 29.9%, which were 93.3% and 79.1% for HIV-negative patients. The death rate due to tumor recurrence and liver failure in the HIV-positive patients was apparently higher than those of the HIV-negative patients (tumor recurrence, 42.3% vs. 17.3%, P = 0.016; liver failure, 19.2% vs. 2.7%, P = 0.012, respectively). Independent factors predicting survival were initial presentation, HIV serostatus, United Network of Organ Sharing-modified tumor-node-metastasis stage, Barcelona Clinic Liver Cancer stage, aspartate aminotransferase, histological pattern, and microvascular invasion. Conclusions: HIV-positive subjects with HCC have a poorer survival outcome than their HIV-negative counterparts, with tumor recurrence and liver failure as the main causes of death. Despite adequate curative therapy, HIV serostatus is associated with decreased survival of patients with HCC, independent of symptomatic presentation, tumor staging, and liver function.