In the Journals

HIV providers less likely than hepatologists to screen for HCC

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August 20, 2015

HIV providers were less likely than hepatologists to follow practice guidelines for hepatocellular carcinoma screening in patients with HIV/hepatitis B coinfection, according to recent data.

Bevin Hearn, MD, of the Carolinas HealthCare System in Charlotte, North Carolina, and colleagues compared HIV providers’ and hepatologists’ understanding of and adherence to the American Association for the Study of Liver Diseases (AASLD) guidelines for chronic hepatitis B management at a large, metropolitan academic medical center.

Using ICD-9 codes, the researchers retrospectively identified 114 patients coinfected with HIV and hepatitis B and 225 patients with just hepatitis B. All patients were seen in outpatient clinics at least twice a year over 2 years, the researchers wrote. Chart reviews were performed to evaluate providers’ adherence to AASLD guidelines, and data on provider awareness were collected through an online, anonymous survey. Thirty-five providers responded to the survey.

Results showed that at this institution, HIV providers were less likely to screen for HCC than hepatologists. Over 2 years, 36% of patients seen in HIV practices were screened for HCC vs. 81.8% of patients in hepatology practices, the researchers wrote. In all, 1.8% of screened HIV/hepatitis B patients had evidence of HCC compared to 16% of those with hepatitis B mono-infection.

In addition, HIV providers were less likely to monitor patients’ hepatitis B viral loads (P < 0.0001), HBeAG and anti-HBe (P < 0.00001), HBsAg and anti-HBs (P < 0.00001) than hepatologists, the researchers wrote. However, HIV providers were more likely to screen for hepatitis A immunity (P = 0.028).

“Given the 8-fold increased risk of death related to liver disease in HIV/HBV coinfection and a 7-fold increased risk for HCC compared to HBV monoinfection, this study and published findings strongly indicate that improving HCC screening practices should be a priority for HIV clinicians caring for HIV/HBV coinfected patients,” Hearn and colleagues wrote.

Suggestions from the researchers to improve compliance among providers included offering HIV providers education focused on hepatitis care, electronic medical record order sets and progress notes templates prepopulated with lab tests and HCC screening. by Colleen Owens

Disclosure: Hearn reports no relevant financial disclosures. Please see full study for a list of all other authors’ relevant financial disclosures.