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

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Title: The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma
Authors: Pinato, DJ
Sharma, R
Citti, C
Platt, H
Ventura-Cots, M
Allara, E
Chen, T-Y
Dalla Pria, A
Jain, M
Minguez, B
Kikuchi, L
West, EK
Merli, M
Kaplan, DE
Hasson, H
Marks, K
Nelson, M
Nunez, M
Aytaman, A
Bower, M
Brau, N
Item Type: Journal Article
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.
Issue Date: 16-Oct-2017
Date of Acceptance: 11-Sep-2017
URI: http://hdl.handle.net/10044/1/57411
DOI: https://dx.doi.org/10.1111/apt.14356
ISSN: 0269-2813
Publisher: Wiley
Start Page: 95
End Page: 103
Journal / Book Title: Alimentary Pharmacology and Therapeutics
Volume: 47
Issue: 1
Copyright Statement: © 2017 John Wiley & Sons Ltd. This is the peer reviewed version of the article, which has been published in final form at https://dx.doi.org/10.1111/apt.14356. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Sponsor/Funder: St Stephen's Aids Trust
Funder's Grant Number: N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Pharmacology & Pharmacy
IMMUNODEFICIENCY-VIRUS-INFECTION
ALBI GRADE
LIVER-FUNCTION
CIRRHOSIS
COINFECTION
CANCER
CLASSIFICATION
INDIVIDUALS
SURVIVAL
THERAPY
Liver Cancer in HIV Study Group
1103 Clinical Sciences
1115 Pharmacology And Pharmaceutical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine



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