Incidence of and Factors Associated with Hepatocellular Carcinoma among Hepatitis C Virus and Human Immunodeficiency Virus Coinfected Patients with Decompensated Cirrhosis

Abstract

We compared the incidence of and factors associated with hepatocellular carcinoma (HCC) among hepatitis C virus (HCV)-monoinfected subjects and human immunodeficiency virus (HIV)/HCV-coinfected individuals, both with decompensated cirrhosis. In a retrospective study, a cohort of 180 individuals with HIV coinfection and 1037 HCV-monoinfected patients with decompensated HCV-related cirrhosis from eight centres in Spain were analyzed. HCC was found in 234 (23%) HCV-monoinfected subjects and in four (2%) HIV-coinfected subjects (p<0.001). At the time of the first hepatic decompensation, 188 (17%) and 4 (2%) (p<0.001) patients in the former and in the latter group, respectively, showed HCC. Fifty-four (11%) patients without HCC at baseline developed such a disease during follow-up. There were no incident cases among the HIV-coinfected population. The density of incidence (95% IC) of HCC in HIV/HCV-coinfected and HCV-monoinfected patients was 0 (0-1.70) and 3.31 (2.70-4.64) cases per 100 person-years (p<0.001), respectively. Lack of HIV infection [adjusted odds risk (AOR) (95% IC)=16.7 (3.9-71.1)] and high alanine aminotransferase levels [AOR (95% IC)=2.5 (1.1-5)] were the only two independent predictors of the emergence of HCC. In the group of patients in whom the date of HCV infection could be estimated, the time elapsed until HCC diagnosis was shorter among HIV-coinfected subjects. The incidence of HCC in patients with HCV-related cirrhosis after the first hepatic decompensation is lower in HIV-coinfected patients. This is probably due to the fact that HIV infection shortens the survival of HCV-coinfected patients with end-stage liver disease to such an extent that HCC not had a chance to emerge.

Clinical progression of hepatitis C virus-related chronic liver disease in human immunodeficiency virus-infected patients undergoing highly active antiretroviral therapy

“…The low incidence of HCC is probably due to the fact that the length of HCV infection in the patients included in this study is still short, so that HCC, a late complication of HCV-related chronic liver disease, has little chance to emerge. 31 As the follow-up of these patients increases, likely the incidence of HCC becomes greater. Higher frequencies of consumption of depressors of central nervous system and of bacterial infections have been proposed as possible causes of the greater incidence of HE in coinfected patients compared with that found in HCV-monoinfected individuals.…”

The Role of Viral Co-Infection in HIV-Associated Non-AIDS-Related Cancers

“…HIV infection itself has not been associated with an increased risk of HCC [57, 58]. A PubMed literature search for HIV infection and HCC yielded few studies from the US and Europe that looked at the effect of HIV infection on the incidence, characteristics and progression of HCC (summarized in Table 1).…”

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

“…It has also been reported that in HIV/HCV-coinfected patients, HIV may promote the development of cirrhosis 10 to 20-fold, and that of HCC five-fold [33]. Some authors have compared the incidence of HCC in HIV/HCV-coinfected patients with that seen in HCVmonoinfected patients in large, retrospective cohorts, and they described a still higher incidence of HCC among HCV-monoinfected patients than in HIV/HCV-coinfected patients, mainly due to the longer duration of HCV infection in the monoinfected group [34,35]. However, Ioannou et al [6] reported a greater progression in the prevalence of cirrhosis and HCC in the HIV/HCV population (3.7-fold for cirrhosis and 23-fold for HCC) than among HCV-monoinfected patients, because of the accelerated course of liver disease in the former group.…”