1676. Mortality and Treatment Complications of Hepatocellular Cancer in those with and without HIV-Infection
Session: Poster Abstract Session: HIV: HIV/HCV Co-Infection Treatment and Complications
Saturday, October 10, 2015
Room: Poster Hall
Background: Hepatocellular carcinoma diagnosis (HCC) is rising in incidence and represents a significant burden of disease among those with viral hepatitis. The most common treatment modalities available to patients with unrespectable  HCC include transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and systemic chemotherapy.  We compare the experience in treatment and procedural TACE complications (TACE-Cs) among HCC patients with and without HIV.

Methods: Utilizing case-registries, a  retrospective review was conducted of viral-hepatitis associated HCC at our center (2000-2014). Demographic characteristics and lab values at HCC diagnosis, imaging and all procedural reports, admission records and outpatient clinical visits were reviewed to capture outcomes and events post-HCC diagnosis. 

Results: In 14 yr period, 175 male veterans with HCC were identified with HIV-infection representing 6.3% (11/175).  At diagnosis, mean age was 60.4yrs±7.7yrs, with 95.4% of all pts >50yr of age; the majority were black (120/175, 68.6%) and in HIV+ the BMI was significantly lower (-4.6 kg/m2 , P<0.03).  The majority (72.7%) of HIV+ were on ARV at diagnosis; mean CD4 of 396±166 cells/mm3and 63.6% with undetectable VL.  All-cause mortality was 72.6% (HIV+  90.9% vs HIV- 71.3%, P=NS); the median time to death after HCC diagnosis was 1yr (maximum survival was 5yr both HIV-/+) with 76.2% dying within 1-yr, 46.8% in the same year.  Of treatments received, the most utilized was TACE (37.1%), followed by RFA (28.0%) and chemotherapy (20.6%). Procedure events totaled 210, with 143 TACEs.  The most common TACE related complications were pain (10%), post-embolization syndrome (8%) and infection (5%).  Composite TACE complication rates were not different between the groups (29% vs 26%, P=NS), however infections were significantly higher among HIV+ (29% vs 4%, P=0.04)

Conclusion: In unrespectable patients, significant mortality was associated at or close to HCC diagnosis.  The majority of procedural complications in those surviving to receive therapy were no different for those with HIV-infection.  HIV was a risk for TACE-related infectious complications despite most HCC diagnoses occurring in those engaged in care and on ARVs with evidence of virologic control.

Ribka Ayana, MD1,2 and Angelike Liappis, MD1,2, (1)Washington DC Veterans Affairs Medical Center, Washington, DC, (2)George Washington University, Washington, DC


R. Ayana, None

A. Liappis, None

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