Outcomes of TACE in HIV-Positive Patients with Hepatocellular Carcinoma
22 March 2018 (online)
Purpose To investigate the safety and effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients with comorbid HIV infection.
Materials and Methods Ninety TACE procedures in 31 HIV-positive patients (mean CD4 340, 100% on antiretroviral therapy) were examined in this single-arm retrospective study. All patients were male with an average age of 57.0 years (range: 37.7–68.4). Risk factors for HCC included chronic hepatitis C (61%), chronic hepatitis B (26%), and multifactorial (13%). In 58% of cases, TACE was performed for patients within the Milan Criteria and listed for liver transplant. Sixteen percent of patients underwent TACE in an attempt to downstage into Milan Criteria, while 26% underwent TACE for palliative purposes. For each procedure, changes in laboratory values, adverse events, and response rates were assessed. Overall survival (OS) and transplant rates were also determined.
Results Symptoms of post-embolization syndrome were reported after 46% of TACE procedures. Hyperbilirubinemia was the most common post-procedure laboratory abnormality (58%). One infectious complication (urinary tract infection) occurred within 1 month of TACE. Complete response and partial response on follow-up cross-sectional imaging was noted after 34% and 52% of TACE procedures, respectively. Fourteen percent of procedures yielded no response or locally progressive disease. Of 21 eligible transplant candidates, 14 received transplants, and three remain listed. Mean OS for palliative patients was 16 months from the initial treatment, with a mean 3.4 treatment sessions (range: 1–7) per patient.
Conclusion TACE is a safe and effective treatment for HCC in patients with co-morbid HIV infection.