Levels of Alpha-Fetoprotein and Association with Mortality in Hepatocellular Carcinoma of HIV-1-Infected Patients

Abstract

Background and Aim. The clinical course of hepatocellular carcinoma (HCC) is determined by cancer-related and nonrelated factors. We evaluated the effect of a cancer-related factor, alpha-fetoprotein (AFP) levels, on mortality in HIV-1-infected patients with HCC. Methods. This is a retrospective cohort study on patients living with HIV-1 infection (PLWH) followed at the Division of Infectious Diseases of the San Raffaele Hospital, with cirrhosis and HCC diagnosed between 1999 and 2018 and with an available AFP value at HCC diagnosis. The area under the receiver operating characteristic curve (AUC) was used to estimate the accuracy of baseline AFP in predicting death. Factors associated with the risk of death were identified using multivariable Cox proportional-hazards regression models. Results. Overall, 53 PLWH were evaluated: 18 patients received a curative treatment (9 liver transplantation, 5 liver resections and 4 radiofrequency ablation) and 35 a noncurative treatment (17 chemo or radio embolization, 10 sorafenib and 8 best supportive care). Baseline AFP was predictive of death [AUC 0.71, 95% confidence interval (CI) 0.54–0.83], and the optimal cut-off was 28.8 ng/mL. At multivariable analysis, BL AFP ≥28.8 ng/mL was associated with death [adjusted hazard ratio (aHR) 7.05, 95% CI 1.94–25.71 P = 0.003]. Other factors were HBV infection (aHR 8.57, 95% CI 1.47–50.08, P = 0.017) and treatment allocation (curative vs. noncurative, aHR 0.08, 95% CI 0.02–0.40, P = 0.0004). Conclusions. Our findings suggest that in PLWH AFP serum levels ≥28.8 ng/mL, HBV coinfection and treatment allocation represent predictive markers for death at the time of HCC diagnosis.

Case Report: Lenvatinib for the treatment of recurrent hepatocellular carcinoma in people living with HIV: a report of two cases

“…We previously showed that, among participants with advanced BCLC (stage D) and low liver functional reserve (CPT B/C), treatment discontinuation due to adverse events occurred in a minority of participants, suggesting that systemic treatment with sorafenib is well tolerated in PLWH, despite advanced HCC stage ( 10 ). Conversely, the presently reported two cases with a good liver functional reserve and an intermediate BCLC score showed low tolerability to systemic treatment with lenvatinib.…”

Survival in People Living with HIV with or without Recurrence of Hepatocellular Carcinoma after Invasive Therapy

“…Very recently, we showed in PLWH with HCC that AFP at a precise cut-off is associated with a worse prognosis, considering all treatment options [ 22 ]. In the present study, which included PLWH who received IT, the AFP at values < 28 ng/mL emerged as an independent survival-related factor, confirming the importance of this biological marker in the prognosis of HCC also at an early stage since 48% of participants had BCLC 0/A.…”

“…Alpha-fetoprotein levels were also stratified according to the cut-off levels of 28 ng/mL, which we previously found associated with survival in PLWH with HCC [ 22 ]. Hepatitis B, C, and Delta infections were assessed by the presence of hepatitis B surface antigen [HBsAg], hepatitis C, and hepatitis Delta antibody positivity (anti-HCV and anti-HDV, respectively).…”