Yttrium-90 (Y-90) radioembolization to treat liver cancer appears safe and effective in people living with HIV, with a recent study finding no significant adverse events in patients as a result of the procedure.
The study is the first to assess outcomes of the procedure in people living with HIV, as these patients are often excluded due to immunodeficiency concerns, noted lead author Kartikeya Menon, MD, of Mount Sinai Hospital in New York City.
“These data suggest that the known lymphotoxicity of Y-90 [radioembolization] is not immunosuppressive enough to allow opportunistic infections in HIV+ patients on antiretroviral regimens,” the researchers wrote. The study was published January 10 in the Journal of Vascular and Interventional Radiology.
Y-90 radioembolization is used to treat liver cancer. For the procedure, an interventional radiologist inserts a catheter into the artery in the groin, guides it to the hepatic artery, and then releases Y-90 microbeads into the small vessels that feed the tumor to deliver radiation.
Early use of Y-90 radioembolization in patients without HIV has indicated that lymphopenia — abnormally low white blood cells — is a common adverse event, yet the safety of treatment-induced lymphopenia and risk of opportunistic infections in HIV-positive patients undergoing the procedure is unknown, the authors explained.
To address the knowledge gap, the group reviewed data on all patients with hepatocellular carcinoma (HCC) who underwent Y-90 radioembolization at their hospital between January 2014 and June 2023. They identified 39 patients with documented HIV-positivity prior to the procedure. Among these, CD4 and total lymphocyte counts and HIV viral load data were available for 19 patients within 12 weeks of therapy.
According to the analysis, for the 19 patients, mean CD4 lymphocyte counts dropped from 374.3/mm3 to 180.3/mm3 27 (p < 0.001) after Y-90 radioembolization, but rebounded to 320.9/mm3 28 at 12-month follow up (p = 0.01). The overall response rate was 87.2% and the disease control rate was 97.4%. Median overall survival was 35.8 months and median progression-free survival was 14.7 months.
Finally there were no grade 3 (life-threatening) adverse events in the patients, three grade 3 biochemical toxicities (not immediately life-threatening), and one opportunistic infection 18 months following the procedure, the researchers reported.
“Y-90 [radioembolization] is safe and effective in people living with HIV with HCC. No significant HIV-related adverse events were attributable to radioembolization,” the group wrote.
The outcomes and progression metrics in this study were comparable to studies in other populations published in the literature, the researchers noted. Nonetheless, this was a single-arm study and limited by study size and design, the group noted.
“This is the first study of Y-90 [radioembolization] outcomes in people living with HIV, a demographic often excluded from retrospective and prospective clinical investigations,” the group wrote.
The full study is available here.