TY - JOUR
T1 - Survival outcomes in veterans with hepatocellular carcinoma, with and without HIV infection
AU - Sada, Yvonne H.
AU - Da Costa, Wilson L.
AU - Kramer, Jennifer R.
AU - Chiao, Elizabeth Y.
AU - Zafeiropoulou, Efthalia
AU - Dong, Yongquan
AU - Chen, Liang
AU - Dang, Bich N.
N1 - Funding Information:
This study was supported by a seed award from the Baylor College of Medicine Precision Medicine/Population Health Initiative, 2019–2020 (PI B. Dang). The study was also supported in part by a PQ3 grant funded by the National Institute of Health (R01 R01CA206476 and NI1R01CA260689-01; PI E. Chiao), and the facilities and resources of the Houston VA Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
Funding Information:
This study was supported by a seed award from the Baylor College of Medicine Precision Medicine/Population Health Initiative, 2019-2020 (PI B. Dang). The study was also supported in part by a PQ3 grant funded by the National Institute of Health (R01 R01CA206476 and NI1R01CA260689-01; PI E. Chiao), and the facilities and resources of the Houston VA Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
Funding Information:
At the time of this study, W.L.dC. was a postdoctoral research fellow supported by a Research Training Award from the Cancer Prevention & Research Institute of Texas (CPRIT). He was a part of the Cancer Prevention Post-Graduate Training Program in Integrative Epidemiology (RP160097) and Systems Epidemiology of Cancer Training (SECT) Program (RP210037) at the Baylor College of Medicine.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/7/15
Y1 - 2023/7/15
N2 - Background:HIV infection has been associated with survival disparities among persons with hepatocellular carcinoma (HCC). However, most studies examining survival do not control for provider (e.g. type of HCC treatment given) or individual-level factors (e.g. homelessness, substance use) that could impact survival. In this study, we evaluate the effect of HIV status on survival among persons with HCC, in a comprehensive model that accounts for key individual, provider, and systems-level factors.Methods:We conducted a retrospective cohort study of persons with HIV (PWH) matched 1 : 1 to HIV-negative controls based on age and year of HCC diagnosis in the national Veterans Administration (VA) health system. The primary outcome was survival. We used Cox regression models to evaluate the effect of HIV status on risk of death.Results:This cohort included 200 matched pairs diagnosed with HCC between 2009 and 2016. A total of 114 PWH (57.0%) and 115 HIV-negative patients (57.5%) received guideline-concordant therapy (P = 0.92). Median survival was 13.4 months [95% confidence interval (CI) 8.7-18.1] among PWH and 19.1 months (95% CI 14.6-24.9) for HIV-negative patients. In adjusted models, older age, homelessness, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and not receiving any HCC treatment predicted risk of death. HIV status was not associated with risk of death [adjusted hazard ratio (aHR) 0.95; 95% CI 0.75-1.20; P = 0.65].Conclusion:HIV status was not associated with worse survival among HCC patients, in a single-payer, equal access healthcare system. These results suggest that HIV infection alone should not exclude PWH from receiving standard therapy.
AB - Background:HIV infection has been associated with survival disparities among persons with hepatocellular carcinoma (HCC). However, most studies examining survival do not control for provider (e.g. type of HCC treatment given) or individual-level factors (e.g. homelessness, substance use) that could impact survival. In this study, we evaluate the effect of HIV status on survival among persons with HCC, in a comprehensive model that accounts for key individual, provider, and systems-level factors.Methods:We conducted a retrospective cohort study of persons with HIV (PWH) matched 1 : 1 to HIV-negative controls based on age and year of HCC diagnosis in the national Veterans Administration (VA) health system. The primary outcome was survival. We used Cox regression models to evaluate the effect of HIV status on risk of death.Results:This cohort included 200 matched pairs diagnosed with HCC between 2009 and 2016. A total of 114 PWH (57.0%) and 115 HIV-negative patients (57.5%) received guideline-concordant therapy (P = 0.92). Median survival was 13.4 months [95% confidence interval (CI) 8.7-18.1] among PWH and 19.1 months (95% CI 14.6-24.9) for HIV-negative patients. In adjusted models, older age, homelessness, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and not receiving any HCC treatment predicted risk of death. HIV status was not associated with risk of death [adjusted hazard ratio (aHR) 0.95; 95% CI 0.75-1.20; P = 0.65].Conclusion:HIV status was not associated with worse survival among HCC patients, in a single-payer, equal access healthcare system. These results suggest that HIV infection alone should not exclude PWH from receiving standard therapy.
KW - guideline-concordant therapy
KW - hepatocellular carcinoma
KW - HIV infection
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85164210217&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85164210217&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000003568
DO - 10.1097/QAD.0000000000003568
M3 - Article
C2 - 37070557
AN - SCOPUS:85164210217
SN - 0269-9370
VL - 37
SP - 1387
EP - 1397
JO - AIDS
JF - AIDS
IS - 9
ER -