Survival outcomes in Veterans with hepatocellular carcinoma, with and without HIV infection.

Abstract

HIV infection has been associated with survival disparities among persons with hepatocellular carcinoma (HCC). However, most studies examining survival do not control for provider- (e.g. type of HCC treatment given) or individual-level factors (e.g. homelessness, substance use) that could impact survival. In this study, we evaluate the effect of HIV status on survival among persons with HCC, in a comprehensive model that accounts for key individual-, provider- and systems-level factors. We conducted a retrospective cohort study of people living with HIV (PLWH) matched 1:1 to HIV-uninfected controls based on age and year of HCC diagnosis in the national Veterans Administration (VA) health system. The primary outcome was survival. We used Cox regression models to evaluate the effect of HIV status on risk of death. This cohort included 200 matched pairs diagnosed with HCC between 2009-2016. A total of 114 PLWH (57.0%) and 115 HIV- patients (57.5%) received guideline-concordant therapy (P = 0.92). Median survival was 13.4 months (95% CI 8.7-18.1) among PLWH and 19.1 months (95% CI 14.6-24.9) for HIV-uninfected patients. In adjusted models, older age, homelessness, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and not receiving any HCC treatment HCC predicted risk of death. HIV status was not associated with risk of death (aHR 0.95 [95% CI 0.75-1.20]; P = 0.65). HIV status was not associated with worse survival among HCC patients, in a single-payer, equal access health care system. These results suggest that HIV infection alone should not exclude PLWH from receiving standard therapy.