Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: a U.S.-Canadian multicenter study.

BACKGROUND/AIMS: HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus coinfection. Limited data are available on those with hepatocellular carcinoma (HCC). METHODS: A retrospective analysis from 1992 to 2005 in 6 centers identified 63 HIV-infected HCC patients. Controls were 226 consecutive HIV-negative HCC patients from four sites. RESULTS: HIV-positive patients were younger than controls (52 vs. 64 years, p<0.001), more commonly had chronic hepatitis B or C (97% vs. 73%, p<0.001), were more frequently symptomatic (51% vs. 38%, p=0.048), had a higher median alfa-fetoprotein level (227 vs. 51 ng/ml, p=0.005), but a similar mean Child-Turcotte-Pugh score (7.0 vs. 7.5, p=0.05) and HCC staging score (Barcelona-Clínic-Liver-Cancer stages C+D in 50% vs. 58%, p=0.24). HCC developed faster in HIV/HCV-coinfected than in HCV-monoinfected patients (mean, 26 vs. 34 years after HCV infection, p=0.002). HIV-positive patients received proven therapy more often (48% vs. 31%, p=0.017), but median survival was similar (6.9 vs. 7.5 months, p=0.44). Independent factors predicting survival were symptomatic presentation (hazard ratio [HR], 0.437; p<0.001), any proven therapy (HR, 2.19; p<0.001), diagnosis after 01-Jan-2002 (HR, 1.52; p=0.010), Barcelona-Clínic-Liver-Cancer stages C+D (HR, 0.491; p<0.001), AST/ALT >or= 2.00 (HR, 0.597; p=0.001), AFP >or= 400 ng/mL (HR, 0.55, p=0.003), and platelets >or= 100,000/mm3 (HR, 0.651; p=0.012), but not HIV-serostatus (p=0.19). In HIV-infected patients without HCC therapy (n=33), median survival was longer with undetectable HIV RNA (<400 copies/mL) than with HIV viremia (6.5 vs. 2.6 months, p=0.013). CONCLUSIONS: HIV-positive HCC patients are younger and more frequently symptomatic and infected with HCV or HBV than HIV-negative patients. Tumor staging and survival are similar. In untreated patients, undetectable HIV RNA independently predicts better survival.

Three-Dimensional Echocardiographic Assessment of Aortic Dissection.

In the present study, we report our experience of using three-dimensional reconstruction of transesophageal two-dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).

Transesophageal Three-Dimensional Echocardiographic Assessment of Normal and Stenosed Coronary Arteries.

We describe our preliminary experience in assessing normal and stenosed coronary arteries using transesophageal three-dimensional echocardiography (3-D echo) in 27 adult patients. Multiplane transesophageal two-dimensional images of the coronary arteries (20 left, 3 right, 3 both left and right, and 1 posterior descending) were first acquired in the TomTec computer in 3 degrees sequential increments, from 0 degrees to 180 degrees, and then 3-D reconstruction was performed. The entire left main (LMC, measuring 0.5 to 1.7 cm, mean 1.0 cm) as well as variable lengths of proximal or both proximal and middle segments of the left anterior descending (LAD, measuring 0.2 to 2.5 cm, mean 0.8 cm) and circumflex (LCX, measuring 0.2 to 2.8 cm, mean 0.9 cm) coronary arteries together with some of their branches could be visualized in 3-D in 22 of 23 patients. In the remaining patient, the LMC was absent, and both LAD and LCX could be visualized in 3-D as having separate but adjacent origins from the left sinus of Valsalva (proven by angiography). In two patients, long segments of interventricular and great cardiac veins were also visualized accompanying the LAD and LCX, respectively. The right coronary artery (RCA, measuring 0.7 to 3.0 cm, mean 1.9 cm) was also successfully delineated in 3-D in all six patients in whom an attempt was made to visualize it during echo examination. Using the transgastric approach, a long (1.8 cm) segment of the posterior descending branch (PDA) of RCA was imaged in one patient. In addition, nine significantly stenotic lesions (>50% lumen diameter) were identified by 3-D in eight patients involving LMC (1), proximal LAD (1), mid LAD (1), proximal LCX (2), proximal RCA (3), and mid PDA (1). Eight of these 9 lesions were confirmed by coronary angiography. The remaining lesion (mid PDA) could not be confirmed since the patient did not undergo angiography. Our preliminary study demonstrates the usefulness of transesophageal 3-D echo not only in delineating normal coronary arteries but also diagnosing significant atherosclerotic stenosis in these vessels. (ECHOCARDIOGRAPHY, Volume 13, September 1996)