Hepatitis B virus-associated hepatocellular carcinoma in South Africa in the era of HIV

Abstract

Background: Patients co-infected with hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are at risk of developing hepatocellular carcinoma (HCC). In sub-Saharan Africa, the overlap between high HIV and HBV prevalence may increase the incidence of HCC. This study investigated the impact of HBV/HIV co-infection on age at presentation and survival of HCC. Methods: Ethical approval was obtained to recruit, following informed written consent, patients diagnosed with HCC at oncology units at four South African hospitals. Between December 2012 and August 2015, patients newly diagnosed with HCC were recruited and provided demographic and clinical data and blood specimens. Patients were tested for HBV, hepatitis C virus (HCV) and HIV. Survival data was available for a subset of patients. Results: Of 107 HCC cases, 83 (78%) were male. Median age was 46 years (range 18 to 90 years), 68/106 (64%) were HBsAg-positive, and 22/100 (22%) were HIV infected. Among HBV surface antigen (HBsAg)-positive HCC cases, 18/66 (27%) were HIV-infected compared to 3/34 (9%) among those that were HBsAg-negative (p = 0.04). A greater proportion of HBV/HIV co-infected cases were female than HBV mono-infected (6/18, 33% vs 6/47, 13%; p = 0.005). In addition, HBV/HIV co-infected females presented at a younger mean age (36.8 years) than HBV mono-infected women (50.5 years) (p = 0.09). Median survival was 82 days among the HIV-infected HCC patients compared to 181 days among those without HIV (p = 0.15). Conclusions: HCC is an important complication in the HIV/HBV infected patient. HIV-positive patients presented with HCC at a younger age than HIV-negative patients, this effect appears to be greater in women. These data provide more evidence supporting the call to address. HCC as a cause of morbidity and mortality in the HBV/HIV co-infected patient population. (281 words).

Viral Hepatitis Associated Hepatocellular Carcinoma on the African Continent, The Past, Present, and Future: A Systematic Review.

“…Human immunode ciency virus (HIV) could also have an impact on the trends of HBV and HCV, and the development of HCC in Africa. With HIV, HBV infections are likely to become chronic, therefore the development of HCC may occur quicker in HIV patients with chronic viral hepatitis than non-HIV infected individuals [41].…”

Hepatitis B-related hepatocellular carcinoma: surveillance strategy directed by immune-epidemiology

“…In this regard, certain areas in Kenya and the Gambia are considered high in aflatoxins, but proper studies have not been performed in most regions of the continent [81,82] . Historically, western Africa also bears a higher proportion of HBV-infected individuals and therefore this region should be a special focus for assessment and screening [83,84] . It is likely, however, that a vaccine-related epidemiological balance as well as intrinsic continental mobility has led to a more homogenous risk of HBV-related HCC in most of sub-Saharan Africa.…”

“…Moreover, the relatively uniform spread of HIV and therefore HBV-HIV coinfection has also played a differential role in modifying the epidemiology. This is becoming clear with newer studies showing high incidence of HCC in eastern and southern regions of the continent [ 71 , 85 ] .…”

Viral hepatitis associated hepatocellular carcinoma on the African continent, the past, present, and future: a systematic review

“…The box represents the mean estimate (prevalence), and whiskers correspond to the error margin (HBV = 3.5%, HCV = 3.3%) around the estimated mean could also have an impact on the trends of HBV and HCV, and the development of HCC in Africa. With HIV, HBV infections are likely to become chronic, therefore the development of HCC may occur quicker in HIV patients with chronic viral hepatitis than non-HIV infected individuals [41].…”