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HIV-infected patients with liver cancer who are waiting for a liver transplant are more likely to drop off the transplant waiting list than other patients, a new study has found.
But the researchers also found that the overall survival and cancer recurrence-free survival of HIV-infected patients after a liver transplant is the same as other patients.
This finding is especially important because in an era when more HIV patients survive with the use of highly active antiretroviral therapy, end-stage liver disease has now become the main cause of death among HIV patients who are also infected with chronic hepatitis B virus or hepatitis C virus, according to background material in the study. In addition, studies have shown that one-fourth of liver-related mortality in HIV-positive patients is attributable to liver cancer.
The study
In the new study, French researchers analysed data from 21 HIV-positive and 65 HIV-negative patients with liver cancer who were placed on a liver transplant list between 2003 and 2008. The drop-out rate from the waiting list was 23% for the HIV-positive patients and 10 percent for those without HIV, the investigators found.
Among HIV-infected patients, the drop-out factor was related to the patients' alpha-fetoprotein (AFP) levels. Previous research indicates that a greater than 15 microgram per litre (mcg/L) increase per month in a patient's AFP levels while on a liver transplant waiting list is a major predictive risk factor for liver cancer recurrence after a transplant.
Patients with HIV who dropped off the list had much higher AFP levels than those who eventually received a liver transplant -- 98 mcg/L versus 12 mcg/L, respectively. This large degree of difference in AFP levels was not found in HIV-negative patients -- 18 mcg/L for those who dropped off the list versus 13 mcg/L for those who underwent a liver transplant.
"Liver transplantation is the optimum treatment for [liver cancer] and can also be considered for controlled HIV-positive patients with liver cancer," lead author Dr. Rene Adam, from Hospital Paul Brousse, said in a journal news release. "Our study showed that HIV infection impaired the results of liver transplantation on an intent-to-treat basis but exerted no significant impact on overall survival and recurrence-free survival following transplantation."
The researcher also said the study confirmed the importance of AFP levels.
"There is clearly a critical need for more effective neoadjuvant therapy in HIV-positive patients with [liver cancer]; however there are no objective arguments to contraindicate liver transplantation in this group if strict criteria are used for selection and patients are closely monitored until surgery," Adam concluded in the news release.
The study findings were released online in advance of publication in the February print issue of the journal Hepatology.
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