Safety and Effectiveness of Yttrium-90 Radioembolization in People Living with Human Immunodeficiency Virus.

PURPOSE

To investigate whether yttrium-90 (Y) transarterial radioembolization (TARE) is a safe and effective treatment in people living with human immunodeficiency virus (PLWH) with hepatocellular carcinoma (HCC) across the Barcelona Clinic Liver Cancer stage spectrum.

MATERIALS AND METHODS

A retrospective review was conducted of all patients with HCC presented at a multidisciplinary institutional liver tumor board who underwent Y TARE between January 2014 and June 2023. Thirty-nine patients with documented human immunodeficiency virus (HIV) seropositivity prior to Y TARE and adherence to highly active antiretroviral therapy were included. For 19 patients (48.7%), cluster of differentiation 4 (CD4) and total lymphocyte counts and HIV viral load polymerase chain reaction data were collected before and after Y TARE within 12 weeks of therapy. The Kaplan-Meier analysis was used to compute median overall survival (OS) and the Fine-Gray subdistribution hazard model was used to estimate progression-free survival (PFS). Imaging response was assessed by the modified Response Evaluation Criteria in Solid Tumours (mRECIST), and adverse events (AEs) were analyzed per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

RESULTS

For the 19 patients with HIV laboratory data available, the mean CD4 lymphocyte count dropped from 374.3 cells/mm (SD ± 238.9) to 180.3 cells/mm (SD ± 144.3) (P < .001) after Y TARE but rebounded to 320.9 cells/mm (SD ± 234.3) at 12-month follow-up (P = .013). The overall response rate was 87.2% and disease control rate was 97.4%. The median OS was 35.8 months (95% confidence interval [CI], 17.0 months to no estimate), and median PFS was 14.7 months (95% CI, 10.7-28.9 months). No Grade 3 clinical toxicities, 3 Grade 3 biochemical toxicities, and 1 opportunistic infection 18 months following Y TARE were reported.

CONCLUSIONS

Yttrium-90 TARE is safe and effective in PLWH with HCC. No significant HIV-related AEs were attributable to radioembolization.