Incidence of hepatocellular carcinoma in patients with chronic liver disease due to hepatitis B or C and coinfected with the human immunodeficiency virus: A retrospective cohort study

Abstract

AIMTo assess the incidence of hepatocellular carcinoma (HCC) in chronic liver disease due to hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfected with human immunodeficiency virus (HIV).METHODSA retrospective cohort study was performed, including patients with chronic liver disease due to HBV or HCV, with and without HIV coinfection. Patients were selected in the largest tertiary public hospital complex in southern Brazil between January 2007 and June 2014. We assessed demographic and clinical data, including lifestyle habits such as illicit drug use or alcohol abuse, in addition to frequency and reasons for hospital admissions via medical records review.RESULTSOf 804 patients were included (399 with HIV coinfection and 405 monoinfected with HBV or HCV). Coinfected patients were younger (36.7 ± 10 vs 46.3 ± 12.5, P < 0.001). Liver cirrhosis was observed in 31.3% of HIV-negative patients and in 16.5% of coinfected (P < 0.001). HCC was diagnosed in 36 patients (10 HIV coinfected and 26 monoinfected). The incidence density of HCC in coinfected and monoinfected patients was 0.25 and 0.72 cases per 100 patient-years (95%CI: 0.12-0.46 vs 0.47-1.05) (long-rank P = 0.002), respectively. The ratio for the HCC incidence rate was 2.98 for HIV-negative. However, when adjusting for age or when only cirrhotic are analyzed, the absence of HIV lost statistical significance for the development of HCC.CONCLUSIONIn this study, the presence of HIV coinfection in chronic liver disease due to HBV or HCV showed no relation to the increase of HCC incidence.

Impact of antiretroviral therapy containing tenofovir disoproxil fumarate on the survival of patients with HBV and HIV coinfection

“…The other possible explanation is that our patients, though with lower CD4 counts, were younger (median age, 30 vs 35 years). Given that the onset of cirrhosis mostly occurs at a mean age of 40 years and that of HCC diagnosis at 42‐48 years, there might not be sufficient time for HBV to exert its adverse impact on our patients, as demonstrated by the relatively low liver outcomes observed in this study in both HBV/TDF and HBV/non‐TDF group.…”

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

“…Moreover, hepatocytes apoptosis may be promoted by the upregulation of TNF by the HIV surface protein gp120 [58]. In many cohorts of subjects with HIV infection, another factor that could worsen liver damage was the abuse of alcohol and other substances with direct hepatotoxic effects [101].…”

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

“…The median times elapsing between the first positive serological test and the diagnosis of HCC was 15 years [11][12][13][14][15][16][17][18] for HCV and 20 years [15][16][17][18][19][20][21][22][23] for HIV; it was 5 years [1][2][3][4][5][6][7][8] between the diagnosis of cirrhosis and HCC.…”

“…Recently, the D:A:D study, which followed 49 000 HIV positive persons in Europe, United States and Australia calculated an incidence rate of end‐stage liver disease and HCC of 1 per 1,000 person‐years, including a third of HCC . In the Era of Direct‐Acting Antiviral Agents, there is no data concerning the incidence of HCC in HIV/HCV co‐infected (HIV+/HCV+) patients but it is likely to fall in this population, in line with its predicted decline in HCV mono‐infected (HIV−/HCV+) patients …”

“…4 In the Era of Direct-Acting Antiviral Agents, there is no data concerning the incidence of HCC in HIV/HCV co-infected (HIV+/HCV+) patients but it is likely to fall in this population, in line with its predicted decline in HCV mono-infected (HIV−/HCV+) patients. 5,6 Some studies have shown that HIV+/HCV+ patients with HCC have poorer survival than HIV−/HCV+ patients with a more advanced tumour stage at diagnosis. [7][8][9][10][11] Nevertheless, the clinical course of HCC in an HIV-infected setting is still not clearly defined; most studies have involved small samples and many of the HIV patients included were not receiving combined antiretroviral therapy (cART).…”