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.
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