A review of the role of liver resection in the treatment of human immuno-deficiency virus-positive patients with hepatocellular carcinoma


  • Marcio B. Coelho Department of General Surgery, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia https://orcid.org/0000-0001-6254-8109
  • Uira F. Teixeira Department of Digestive Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
  • Fabio L. Waechter Department of Digestive Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
  • Paulo R. O. Fontes Department of Digestive Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
  • Pablo D. Rodrigues Department of Digestive Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil




Hepatocellular carcinoma, Liver resection, HIV-positive, Outcomes


Patients with human immune-deficiency virus (HIV) have increased risk of developing hepatocellular carcinoma (HCC); this neoplasm apparently behaves more aggressively in this population, leading to worse outcomes. Questions remain regarding the best treatment of HCC in these patients, mainly related to the role of surgical resection. Some studies show that, after transplantation, this group of patients has an overall survival rate comparable to that of uninfected patients. This integrative review assesses and summarize the survival outcome of resection in the treatment of HIV-positive patients with HCC. Integrative review of articles published in English, in PubMed and Scielo databases until October 2021, using the terms: HIV, HCC, and resection. Four publications were analyzed in relation to their content and relevance to the research question. We identified 54 patients who underwent surgical resection, with great variability in overall survival between studies (median between 18 and 72 months); only one study demonstrated disease-free survival. There was also great variability in morbidity and mortality rates after the procedure. All studies were non-comparable. Data regarding the impact of surgical resection on survival in HIV-positive patients with HCC are scarce, and questions remain about the best treatment options with curative intent. Further studies on the topic are needed, given the practical implications for decision-making. Therefore, we suggest that the treatment of these patients should still be conducted similarly to that indicated by the main guidelines on the treatment of patients with HCC, without distinction to HIV serology.



Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33.

National Cancer Institute - INCA. Atlas of Cancer Mortality. 2022. Available at: https://www.gov. br/inca/pt-br/centrais-de-conteudo/aplicativos/atlas-de-mortalidade-por-cancer. Accessed on 22 March 2023.

de Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol. 2014;15(1):23-34.

Zhu RX, Seto WK, Lai CL, Yuen MF. Epidemiology of Hepatocellular Carcinoma in the Asia-Pacific Region. Gut Liver. 2016;10(3).

Villanueva A. Hepatocellular Carcinoma. N Engl J Med. 2019;380(15):1450-62.

Ministry of Health Brasil. Epidemiological Bulletins - 2022. Brasília. 2022. Available at: https://www. gov.br/aids/pt-br/centrais-de-conteudo/boletins-epidemiologicos/2022. Accessed on 22 March 2023.

Morrison M, Hughes HY, Naggie S, Syn WK. Nonalcoholic Fatty Liver Disease Among Individuals with HIV Mono-infection: A Growing Concern? Dig Dis Sci. 2019;64(12):3394-401.

Torgersen J, Taddei TH, Park LS, Carbonari DM, Kallan MJ, Mitchell Richards K, et al. Differences in Pathology, Staging, and Treatment between HIV+ and Uninfected Patients with Microscopically Confirmed Hepatocellular Carcinoma. Cancer Epidemiol Biomarkers Prev. 2020;29(1):71-8.

Merchante N, Merino E, López-Aldeguer J, Jover F, Delgado-Fernández M, Galindo MJ, et al. Increasing Incidence of Hepatocellular Carcinoma in HIV-Infected Patients in Spain. Clin Infect Dis. 2013;56(1):143-50.

Sahasrabuddhe V, Shiels MS, McGlynn KA, Engels EA. The risk of hepatocellular carcinoma among individuals with acquired immunodeficiency syndrome in the United States. Cancer. 2012;118(24):6226-33.

Waziry R, Grebely J, Amin J, Alavi M, Hajarizadeh B, George J, et al. Survival following hospitalization with hepatocellular carcinoma among people notified with hepatitis B or C virus in Australia (2000‐2014). Hepatol Commun. 2017;1(8):736-47.

Puoti M, Rossotti R, Garlaschelli A, Bruno R. Hepatocellular carcinoma in HIV hepatitis C virus. Curr Opin HIV AIDS. 2011;6(6):534-8.

Lewin M, Gelu-Simeon M, Ostos M, Boufassa F, Sobesky R, Teicher E, et al. Imaging Features and Prognosis of Hepatocellular Carcinoma in Patients with Cirrhosis Who Are Coinfected with Human Immunodeficiency Virus and Hepatitis C Virus. Radiology. 2015;277(2):443-53.

di Benedetto F, de Ruvo N, Berretta M, Masetti M, Montalti R, di Sandro S, et al. Don’t Deny Liver Transplantation to HIV Patients With Hepatocellular Carcinoma in the Highly Active Antiretroviral Therapy Era. J Clin Oncol. 2006;24(14):e26-7.

Guerrini GP, Berretta M, Guaraldi G, Magistri P, Esposito G, Ballarin R, et al. Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience. Cancers (Basel). 2021;13(18):4727.

Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723-50.

Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.

National Comprehensive Cancer Network. Hepatobiliary Cancers (Version 5. 2022). Available at: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1438. 2022. Accessed on 22 March 2023.

Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. In: JBI Manual for Evidence Synthesis. JBI. 2020.

Garrard J. Review matrix folder: how to abstract the research literature. In: Jones Learning, Bartlett Learning, editors. Health sciences literature review made easy: the matrix method. 4th ed. Burlington, MA. 2017;139-60.

De-la-Torre-Ugarte-Guanilo MC, Takahashi RF, Bertolozzi MR. Sistematic review: general notions. Revista da Escola de Enfermagem da USP. 2011;45(5):1260-6.

Dekkers OM, Egger M, Altman DG, Vandenbroucke JP. Distinguishing Case Series From Cohort Studies. Ann Intern Med. 2012;156(1):37.

D’Amico G, Tarantino G, Ballarin R, Serra V, Pecchi AR, Guaraldi G, et al. Liver Resection for HCC in HIV-infected patients: a single center experience. World Cancer Res J. 2015;2(1):E490.

Zhao H, Li J, Li S, Wang Y, Zhou J, Liu L, et al. Comparative Analysis of Presentation and Outcome After Liver Resection of Patients With Hepatocellular Carcinoma With and Without HIV. JAIDS J Acquired Immune Deficiency Syndromes. 2021;86(3):361-8.

Golse N, Duarte P, Fontana A, Bündchen C, Karam V, Allard MA, et al. Comparative analysis of outcomes after liver resection and liver transplantation for early stages hepatocellular carcinoma in HIV-infected patients. An intention-to-treat analysis. HPB. 2020;22(6):900-10.

Su C, Lei HJ, Chau GY, Hung-Hsu Hung, Jaw-Ching Wu, Cheng-Yuan Hsia, et al. The Effect of Age on the Long-term Prognosis of Patients With Hepatocellular Carcinoma After Resection Surgery. Arch Surg. 2012;147(2):137.

Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications. Ann Surg. 2004;240(2):205-13.

Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The Comprehensive Complication Index. Ann Surg. 2013;258(1):1-7.

Yopp AC, Subramanian M, Jain MK, Mansour JC, Schwarz RE, Balch GC, et al. Presentation, Treatment, and Clinical Outcomes of Patients With Hepatocellular Carcinoma, With and Without Human Immunodeficiency Virus Infection. Clin Gastroenterol Hepatol. 2012;10(11):1284-90.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53.

Kao WY, Chao Y, Chang CC, Li CP, Su CW, Huo TI, et al. Prognosis of Early-Stage Hepatocellular Carcinoma. Medicine. 2015;94(43):e1929.

Proneth A, Zeman F, Schlitt HJ, Schnitzbauer AA. Is Resection or Transplantation the ideal Treatment in Patients with Hepatocellular Carcinoma in Cirrhosis if Both Are Possible? A Systematic Review and Metaanalysis. Ann Surg Oncol. 2014;21(9):3096-107.

Agüero F, Forner A, Manzardo C, Valdivieso A, Blanes M, Barcena R, et al. Human immunodeficiency virus infection does not worsen prognosis of liver transplantation for hepatocellular carcinoma. Hepatology. 2016;63(2):488-98.

Vibert E, Duclos-Vallée JC, Ghigna MR, Hoti E, Salloum C, Guettier C, et al. Liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection. Hepatology. 2011;53(2):475-82.

Benhamou Y, Bochet M, di Martino V, Charlotte F, Azria F, Coutellier A, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. Hepatology. 1999;30(4):1054-8.

Pinato DJ, Dalla Pria A, Sharma R, Bower M. Hepatocellular carcinoma. AIDS. 2017;31(5):603-11.






Review Articles