Introduction: Liver transplantation (LT) has become a consensual treatment for hepatocellular carcinoma (HCC) in human immunodeficiency virus (HIV)-carriers. However, high drop-out rates raise questions to the role of alternative treatments. Our aim was to address the Results of resection in this setting and to compare them against survival after LT in an intention-to-treat analysis. Patients and Methods: Records from all patients with HIV and HCC listed for LT (liver transplant candidates = LTc+) or resection (LR+) between 2000 and 2017 at our tertiary centre were analysed and compared for overall survival (OS) and disease-free survival (DFS). Result: The LTc+ group (n=43) presented with higher MELD scores and more advanced portal hypertension and HCC stages than the LR+ group (n=15), with no differences in epidemiological or co-infection rates. One-, 3-and 5-year intention-to-treat survival rates were: 81%, 60% and 44%, versus 86%, 58% and 58% in the LTc+ and LR+ groups, respectively (p=0.746). Eleven patients dropped out (in all cases before LT). After LT, OS was 81%, 68% and 59% (no difference versus the LR+ group; p=0.844). There tended to be better DFS after LT, reaching 78%, 68% and 56% versus 53%, 33% and 33% in the LR+ group (p=0.062). Time-to-recurrence was significantly longer in the LT+ group (p=0.001). Conclusion: This was the largest series of resections for HCC in HIV+ patients and the first intention-to-treat analysis. Although LT and resection do not always concern the same population, they enable equivalent survival. At the price of a high recurrence rate, resection could be integrated in the global armoury of liver surgeons.
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