Impact of human immunodeficiency virus on hepatocellular carcinoma outcomes: A National Inpatient Sample.

Abstract

e16334 Background: Human Immunodeficiency Virus (HIV) infection continues to pose significant global health challenges, affecting millions of individuals. In addition to its well-documented impact on the immune system, HIV infection has been increasingly associated with a spectrum of non-AIDS-defining cancers, including hepatic cancer. Hepatic cancer, comprising primarily hepatocellular carcinoma (HCC), represents a formidable malignancy with substantial morbidity and mortality rates globally. The convergence of HIV infection and hepatic cancer presents a multifaceted clinical conundrum, characterized by complex interplay between viral factors, immune dysregulation, and oncogenic processes. Methods: We conducted a retrospective study using a Nationwide inpatient sample (NIS) database from 2018 to 2020. We used ICD-10 codes to detect patients with an age > 18 and a primary diagnosis of hepatic cancer. The hospitals were divided into three groups based on the presence of HIV. Mean length of stay, demographics, mortality, and complications were assessed. The chi-square test was used to compare categorical variables, and the white student t-test was used to compare continuous variables. We used multivariate linear and logistic regression methods to analyze the data using STATA 17 software. Results: The total number of patients with hepatic cancer were found to be 261190. Out of them, 2611 patients had HIV. The patient population mostly consisted of white race 66%, African American 13% and Hispanics were 15%. 67% were male and 33% were female. The mean age of patients was 66 years. The presence of HIV was associated with increased length of stay in the hospital (6.9 days vs 5.5 days in patients without HIV, OR 1.3, p-value 0.03). It was also associated with increased mortality in patients with hepatic cancer (n = 195, OR 1.7). It was also observed that patients with HIV had increased odds of complications including acute kidney injury (AKI) (n = 450, OR 1.2), hepatic failure (n = 265, OR 1.9), acute respiratory distress syndrome (ARDS) (n = 10, OR 4.0), and portal hypertension (n = 54, OR 1.5). Conclusions: Presence of HIV in HCC patients was associated with increased length of stay in the hospital, mortality, and complications. Therefore, clinicians should be extra cautious while dealing with HIV in HCC patients. Large scale prospective studies needed to find the outcomes and difference in the severity of HIV with HCC patients in the recent years. Appropriate representation of HIV patients in HCC clinical trials is also needed. Odds ratios with p value for all outcomes. Outcomes N Odds Ratio P-value Mean length of stay NA 1.3 0.03 Mortality 195 1.7 0.03 AKI 450 1.2 0.03 Hepatic failure 265 1.9 0.05 ARDS 10 4.0 0.02 Portal HTN 54 1.5 0.02 N= total number of patients, AKI: acute kidney injury, ARDS: acute respiratory distress syndrome, HTN: hypertension.