Safety and Effectiveness of Yttrium-90 Radioembolization in People Living with HIV

Purpose: To investigate if Yttrium-90 radioembolization (Y90 TARE) is a safe and effective treatment in people living with HIV (PLWH) with hepatocellular carcinoma (HCC) across the BCLC 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 Y90 TARE between January 2014 and June 2023. Thirty-nine patients with documented HIV seropositivity prior to Y90 TARE and adherence to HAART were included. For 19 (48.7%) patients, CD4 and total lymphocyte counts and HIV viral load PCR data were collected before and after Y90 TARE within 12 weeks of therapy. Kaplan-Meier analysis was used to compute median overall survival (OS) and the Fine-Gray sub-distribution hazard model was used to estimate progression-free survival (PFS). Imaging response was assessed by mRECIST and adverse events were analyzed per CTCAE version 5.0.

Results: For the 19 patients with HIV laboratory data available, the mean CD4 lymphocyte count dropped from 374.3 +/- 238.9 cells/mm³ to 180.3 +/- 144.3 cells/mm³ (p<0.001) after Y90 TARE but rebounded to 320.9 +/- 234.3 cells/mm³ at 12-month follow up (p=0.01). The overall response rate (ORR) was 87.2% and the disease control rate (DCR) was 97.4%. Median OS was 35.8 months (95% CI 17.0 months to no estimate [NE]) and median PFS was 14.7 months (95% CI 10.7-28.9 months). There were no grade 3 clinical toxicities, 3 grade 3 biochemical toxicities and 1 opportunistic infection 18 months following Y90 TARE were reported.

Conclusion: Y90 TARE is safe and effective in PLWH with HCC. No significant HIV-related adverse events were attributable to radioembolization.