The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma

DJ Pinato, R Sharma, C Citti, H Platt, M Ventura-Cots, E Allara, TY Chen, A Dalla Pria, M Jain, B Mínguez, L Kikuchi, E Kaufman West, Marco Merli, DE Kaplan, H Hasson, K Marks, M Nelson, M Núñez, A Aytaman, M BowerN Bräu, The Liver Cancer in HIV Study Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM: To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS: Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS: A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P <.001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P <.001). CONCLUSIONS: In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC. © 2017 John Wiley & Sons Ltd.
Original languageEnglish
Pages (from-to)95-103
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number1
DOIs
Publication statusPublished - 2018

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Bilirubin
Albumins
Hepatocellular Carcinoma
HIV
Liver
Liver Diseases
Liver Neoplasms
Coinfection
Survival
Viremia
CD4 Lymphocyte Count
Nuclear Family
Liver Transplantation
Hepatitis
HIV Infections
Chronic Disease
Retrospective Studies
Viruses
Mortality

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The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. / Pinato, DJ; Sharma, R; Citti, C; Platt, H; Ventura-Cots, M; Allara, E; Chen, TY; Dalla Pria, A; Jain, M; Mínguez, B; Kikuchi, L; Kaufman West, E; Merli, Marco; Kaplan, DE; Hasson, H; Marks, K; Nelson, M; Núñez, M; Aytaman, A; Bower, M; Bräu, N; Group, The Liver Cancer in HIV Study.

In: Alimentary Pharmacology and Therapeutics, Vol. 47, No. 1, 2018, p. 95-103.

Research output: Contribution to journalArticle

Pinato, DJ, Sharma, R, Citti, C, Platt, H, Ventura-Cots, M, Allara, E, Chen, TY, Dalla Pria, A, Jain, M, Mínguez, B, Kikuchi, L, Kaufman West, E, Merli, M, Kaplan, DE, Hasson, H, Marks, K, Nelson, M, Núñez, M, Aytaman, A, Bower, M, Bräu, N & Group, TLCIHIVS 2018, 'The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma', Alimentary Pharmacology and Therapeutics, vol. 47, no. 1, pp. 95-103. https://doi.org/10.1111/apt.14356
Pinato, DJ ; Sharma, R ; Citti, C ; Platt, H ; Ventura-Cots, M ; Allara, E ; Chen, TY ; Dalla Pria, A ; Jain, M ; Mínguez, B ; Kikuchi, L ; Kaufman West, E ; Merli, Marco ; Kaplan, DE ; Hasson, H ; Marks, K ; Nelson, M ; Núñez, M ; Aytaman, A ; Bower, M ; Bräu, N ; Group, The Liver Cancer in HIV Study. / The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 47, No. 1. pp. 95-103.
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T1 - The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma

AU - Pinato, DJ

AU - Sharma, R

AU - Citti, C

AU - Platt, H

AU - Ventura-Cots, M

AU - Allara, E

AU - Chen, TY

AU - Dalla Pria, A

AU - Jain, M

AU - Mínguez, B

AU - Kikuchi, L

AU - Kaufman West, E

AU - Merli, Marco

AU - Kaplan, DE

AU - Hasson, H

AU - Marks, K

AU - Nelson, M

AU - Núñez, M

AU - Aytaman, A

AU - Bower, M

AU - Bräu, N

AU - Group, The Liver Cancer in HIV Study

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM: To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS: Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS: A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P <.001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P <.001). CONCLUSIONS: In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC. © 2017 John Wiley & Sons Ltd.

AB - BACKGROUND: Hepatocellular carcinoma (HCC) is a leading cause of liver-related mortality in people living with HIV, where co-infection with hepatotropic viruses accelerates the course of chronic liver disease. AIM: To evaluate whether the albumin-bilirubin (ALBI) grade, a more accurate marker of liver dysfunction in HCC, might identify patients with progressive liver dysfunction in the context of HIV/hepatitis co-infection. METHODS: Using uni- and multi-variable analyses, we studied the albumin-bilirubin grade as a predictor of overall survival (OS) in a large, multi-center cohort of patients with HIV-associated HCC recruited from 44 centres in 9 countries within the Liver Cancer in HIV study group. Patients who underwent liver transplantation were excluded. RESULTS: A total of 387 patients, predominantly HCV co-infected (78%) with balanced representation of all Barcelona Clinic Liver Cancer (BCLC) stages (A = 33%, B = 18%, C = 37%, D = 12%) were recruited. At HCC diagnosis, 84% had been on anti-retrovirals for a median duration of 8.8 years. The albumin-bilirubin grade identified significant differences in median survival of 97 months for grade 1 (95% CI 13-180 months), 17 months for grade 2 (95% CI 11-22 months) and 6 months for grade 3 (95% CI 4-9 months, P <.001). A more advanced albumin-bilirubin grade correlated with lower CD4 counts (464/373/288 cells/mm3 for grades 1/2/3) and higher HIV viraemia (3.337/8.701/61.845 copies/mL for grades 1/2/3, P <.001). CONCLUSIONS: In this large, multi-center retrospective study, the albumin-bilirubin grade highlights the interplay between liver reserve and immune dysfunction as prognostic determinants in HIV-associated HCC. © 2017 John Wiley & Sons Ltd.

U2 - 10.1111/apt.14356

DO - 10.1111/apt.14356

M3 - Article

VL - 47

SP - 95

EP - 103

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 1

ER -