The incidence of hepatocellular carcinoma (HCC) in HIV-infected patients is increasing worldwide. It is not known if HIV-infected patients access effective therapy against HCC. Our aim was to assess the proportion of HIV-infected patients with HCC that do not access recommended therapy according to HCC stage.
The GEHEP-002 multicentric cohort (ClinicalTrials.gov ID: NCT02785835) recruits HCC cases diagnosed in HIV-infected patients from 32 centers from Spain. The Barcelona-Clinic Liver Cancer (BCLC) staging system was used for HCC staging and treatment allocation. The proportion of patients receiving less effective therapy against HCC as indicated by BCLC stage at diagnosis and the evolution of this proportion over time was analyzed.
317 HCC cases from the GEHEP-002 cohort were included in this study. The distribution of patients according to BCLC stage at diagnosis were: Stage 0= 6 (2%); Stage A: 115 (36.3%); Stage B: 26 (8.2%); Stage C: 111 (35%) and Stage D: 59 (18.5%). Eighty-four (32.5%) out of 258 patients who were potentially candidates to therapy did not received therapy or received treatment less effective as indicated by BCLC (Table 1). The proportion of patients receiving no/less effective therapy varied according to the BCLC stage. Thus, it was 25%, 34.6% and 43% in patients at BCLC stage 0/A, B and C, respectively (p<0.0001) (Table 1). Forty-one (43.6%) out of 94 cases diagnosed prior to 2010 and potentially candidates to HCC treatment received no/less effective therapy than recommended, while this occurred in 45 (27.4%) out of 164 cases diagnosed from 2010 (p=0.03). Conversely, the proportion of HCC cases diagnosed at stage 0/A increased in the second period (36 out of 128 [28%] vs. 85 out of 190 [45%]; p < 0.001).
A high proportion of HIV-infected patients diagnosed of HCC did not receive therapy or receive less effective treatment as recommended by its BCLC stage. This situation becomes more frequent as HCC diagnosis is made in a more advanced stage. However, the access to therapy has improved in the recent years, probably as a consequence of the increase in the proportion of HCC cases that are diagnosed in earlier stages.