The incidence of hepatocellular carcinoma has increased among patients coinfected with HIV and hepatitis, according to researchers in Spain.
“Hepatocellular carcinoma (HCC) is emerging as a new clinical problem in the HIV-infected patient, especially in those also infected with hepatitis C virus,” Nicolás Merchante, MD, of the Hospital Universitario de Valme in Sevilla, Spain, told Infectious Disease News. “In our country, HCC incidence has dramatically increased by a factor of 14 in 10 years. Late diagnosis is still a problem, and mortality is high. Clinicians need to be aware of this complication of cirrhosis and implement strategies for early diagnosis, which may allow for potentially curative therapy.”
The study included 82 patients with HIV who developed HCC in Spain before Dec. 31, 2010. All patients were coinfected with hepatitis: 66 had HCV, six had hepatitis B virus and 10 had both HBV and HCV. Twenty-two patients with HIV/HCV coinfection had previously received treatment for HCV. Of those, six achieved sustained virologic response for a median of 28 months until HCC diagnosis.
The first case of HCC in a patient with HIV was reported in 1999. Before Dec. 31, 2004, there were only 16 cases of HCC documented among patients with HIV. After this date, there were 66 new cases diagnosed. Until 2003, the incidence density rate of HCC was between 0 and 0.6 cases per 1,000 person-years. In 2008 and 2009, the incidence density rate of HCC was 2.8 cases per 1,000 person-years.
Most cases of HCC were diagnosed at an advanced stage because of symptoms. Only 30% of the patients met criteria for liver transplantation. Among the patients with HCC diagnosis, 33 received treatment: 11 received potentially curative treatment and 22 received noncurative treatment. Most of the patients (79%) died after HCC diagnosis. The median survival was 91 days, and all deaths except for two were related to HCC.
Among patients who received potentially curative therapy, 28% died vs. 87% who did not receive curative therapy. Median survival after HCC diagnosis was lower in those who received no therapy or noncurative therapy.
“The implications of this study for clinical practice are many,” Merchante said. “Routine screening for HCC in HCV/HIV coinfected patients with cirrhosis is mandatory and infectious disease specialists should be aware of this and adhere to practical guidelines. Prompt referral to and collaboration with multidisciplinary teams is a priority to improve treatment rates and survival.”
Disclosure: The researchers report no relevant financial disclosures.