Salmon D. J Hepatol. 2012;56:862-868.
Patients with HIV, hepatitis C and cirrhosis may be at a higher risk for hepatocellular carcinoma if they are resistant to insulin, according to a recent study.
Researchers evaluated 244 patients with HIV and hepatitis C virus (HCV)-related cirrhosis with no signs of hepatocellular carcinoma (HCC) at baseline. The goal of the study was to determine predictive factors for carcinoma occurrence. Follow-up took place over a median of 2.6 years (IQR, 1.8-3.5).
During follow-up, 21 participants (8.6%) developed HCC, with an incidence of 2.9% at 1 year, 5.3% at 2 years and 6.1% at 3 years. Univariate analyses suggested that factors including age, cirrhosis decompensation, low platelet counts or prothrombin levels, elevated alpha-fetoprotein levels and a homeostasis model assessment (HOMA) value >3.8 were associated with carcinoma occurrence. Participants aged50 years (adjusted RR=3.2, 95% CI, 1.2-9.0) and HOMA value (adjusted RR=3.4, 95% CI, 1.1-10.3) were significantly associated with occurrence following multivariate analyses. Among patients who developed HCC, 66.7% had a baseline HOMA value >3.8, compared with 35.3% of patients who did not (P=.016).
“Insulin resistance seems to play a key role in the occurrence of hepatocellular carcinoma in HCV/HIV co-infected patients with cirrhosis,” the researchers wrote. “This finding calls for specific screening strategies for patients most at risk of developing HCC. Further work is needed to understand how IR increases the risk of HCC in patients with other risk factors, and to develop monitoring strategies for those patients most at risk.”