Do the epidemiology, physiological mechanisms and characteristics of hepatocellular carcinoma in HIV-infected patients justify specific screening policies?

Abstract

Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.

Prognostic factors of survival in HIV/HCV co‐infected patients with hepatocellular carcinoma: The CARCINOVIC Cohort

“…As well as radiological prognostic factors, immunosuppression, well known to accelerate tumour progression, has been confirmed as constituting a higher risk of HCC, which was not supported by our study.…”

“…We recently demonstrated that HCC present with more severe radiological features at diagnosis in HIV+/HCV+ than HIV−/HCV+ cirrhotic patients because of the frequent infiltrative types HCC with portal vein tumour thrombosis . The overall survival of patients who develop HCC is also significantly worsened in HIV+/HCV+ than HIV−/HCV+ patients . However, the therapeutic management and the analysis of prognostic factors for survival in prospective studies have not been taken into account to date.…”

Systemic Inflammatory Response Is a Prognostic Marker in HIV-Infected Patients with Hepatocellular Carcinoma

“…Our case series shares common clinicopathological factors described in previously reported patient cohorts of HIV-associated HCC [26] . Equally, our results rely on the prospective collection of consecutive, unselected referrals to tertiary referral centres, where patients received state-of-the-art oncology and HIV care following multidisciplinary discussion.…”

Cancer prevention in HIV-infected populations

“…Additionally, HIV proteins (tat, gp120) may act on hepatic stellate cells (HSC) to induce inflammation and contribute to fibrosis 93 . Genomic integration of HBV is present in the majority of cases in which HBV-infection leads to HCC 94 , and appears to be facilitated by DNA damage in the setting of chronic inflammation and oxidative stress.…”