Sorafenib therapy for hepatocellular carcinoma in an HIV-HCV coinfected patient: a case report

Abstract

Background/aims: HIV and hepatitis C virus (HCV) share common modes of transmission, resulting in about 33% incidence of coinfection among people infected with HIV. The survival benefit from highly effective antiretroviral therapy (HAART) for HIV infection is resulting in an increased incidence of hepatocellular carcinoma (HCC) in this population. There are no reports to date regarding the coadministration of HAART and sorafenib for hepatocellular carcinoma.

Methods: We report the case of a 42-year-old male patient coinfected with HIV and HCV who developed advanced HCC not amenable to curative therapy. The patient was treated with sorafenib, an oral multikinase inhibitor shown to lead to a longer median survival time and time to progression in patients with advanced HCC. Antiretroviral therapy was continued during sorafenib therapy.

Results: The patient achieved a partial tumor response after 3 months and continued to respond at subsequent assessments. His serum alpha-fetoprotein normalized from 2,172 IU/ml to 2 IU/ml. He had durable stable disease after 23 months of therapy. Antiretroviral therapy was efficacious (CD4(+) lymphocyte count, 377/microl; HIV viremia, <50 copies/ml). The simultaneous administration of these therapies was well tolerated. No grade 3 or 4 toxicities were observed. Exacerbation of pre-existing hypertension, grade 2 diarrhea, and grade 1 skin reaction were observed.

Conclusions: This is the first report in which sorafenib has been successfully used to treat HCC in a patient with HIV-HCV coinfection.

Figure 1.

Sequence of images of contrast-enhanced abdominal CT scan, late phase. (A): Abdominal CT scan at the time of diagnosis of HCC (September 1, 2007). (B): Abdominal CT scan after 3 months on sorafenib (February 26, 2009). (C): Abdominal CT scan after 17 months on sorafenib (April 7, 2009). Abbreviations: CT, computed tomography; HCC, hepatocellular carcinoma.