The impact of HIV on hepatocellular cancer survival in Nigeria

Abstract

Background Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV‐infected individuals. We compared host and tumour characteristics between HIV‐infected and HIV‐uninfected Nigerians with HCC and examined the impact of HIV on survival. Methods This prospective observational study was conducted at Jos University Teaching Hospital in Jos, Nigeria, among adults (>18 years) with HCC enrolled between September 2015 and September 2017 and followed until April 2019. Demographics, tumour characteristics and survival were compared between HCC subjects with and without HIV. Results 101 (10 HIV‐infected and 91 HIV‐uninfected) subjects were enrolled [male 72%; median age 48 (IQR 35–60)]. 60% HIV‐infected subjects were receiving ART; 90% had CD4 counts ≥ 200/mm3 at HCC diagnosis, and 20% had HIV RNA levels < 20 copies/mL. 57.4% were infected with chronic HBV (HBsAg+). The duration of symptoms was shorter in HIV‐infected vs. HIV‐uninfected subjects [93 (IQR 54–132) vs. 155 (93–248] days; p = 0.02]. At the end of follow‐up, 99 of 101 (98.0%) subjects were confirmed to have died: 9 of 10 (90.0%) HIV‐infected and 90 of 91 (98.9%) HIV‐uninfected. The probability of survival at three months was 22% and 47% in HIV‐infected and HIV‐uninfected subjects, respectively (P = 0.02). Median time to death was significantly shorter in HIV‐infected vs. HIV‐uninfected subjects [24 days (IQR 16–88) vs. 85 days (IQR 34–178), respectively (P = 0.03)]. Conclusions High early mortality was observed in this cohort of Nigerian adults with HCC. HIV infection was associated with a faster clinical presentation and shorter survival. More aggressive HCC surveillance may be warranted in HIV‐infected subjects, particularly if they are co‐infected with chronic HBV.

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

“…HBV was also highly prevalent in this cohort (52%), a finding not unexpected since Nigeria is a region that is considered hyperendemic for HBV, with high rates of infection in those with and without HIV (9.9%-13.2%) [ 39 ]. Previous studies have found HBV in over 60% of persons with HCC in Nigeria, similar to our data [ 11 ]. In studies from Asia, both high HBV serum DNA levels and HBeAg seropositivity have been shown to correlate with more advanced HCC disease (portal vein tumor thrombosis and extrahepatic metastases) as well as a higher mortality [ 40 ].…”

Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa: a focus on surveillance

“…A study from Mozambique found that 18% of HCC patients (34 cases) enrolled were infected with HIV, and the majority of these patients (68%) were coinfected with HBV. In addition, HCC presented early in HIV-HBV coinfected patients compared to HIV negative individuals [56] . A study from South Africa demonstrated that females with HIV-HBV coinfection present at a younger age (36 years) compared to HBV mono-infected women (50 years); more importantly, the HIV-infected patients had a lower median survival (82 days) compared to patients without HIV (181 days) [10] .…”

“…A study from South Africa demonstrated that females with HIV-HBV coinfection present at a younger age (36 years) compared to HBV mono-infected women (50 years); more importantly, the HIV-infected patients had a lower median survival (82 days) compared to patients without HIV (181 days) [ 10 ] . Similarly, a prospective study carried out in a Hospital in Nigeria, showed that most patients with HIV and HCC were HBsAg positive, and at three months, the chances of survival in HIV-infected and HIV-uninfected individuals were 22% and 47%, respectively [ 57 ] . A recent report from Ethiopia by Tassachew et al .…”

Loco-Regional Treatments for Hepatocellular Carcinoma in People Living with HIV

“…In fact, it is known that HIV-positive patients arrive at the diagnosis of HCC at a younger age in an intermediate-advanced stage compared to the general population and that they have a clinically more aggressive course—reasons that restrict the choice of practicable therapeutic options [ 35 , 36 ]. Closer surveillance of HCC would therefore be largely warranted in HIV-positive patients to increase the chances of a better outcome [ 11 ], particularly if co-infected with HBV [ 37 ]. Furthermore, a low percentage of HIV patients adhere to cancer screening programs, often not sufficiently promoted by the doctor as a mandatory part of the patient’s clinical management [ 12 , 38 ].…”

“…In PLWH HCC nearly always reveals itself at an advanced stage of disease with limited therapeutical possibilities [ 66 , 67 ]. In most cases, HCC has a faster clinical presentation in PLWH and at a younger age than the general population, resulting in a shorter survival [ 34 , 37 , 68 ]. Furthermore, the overall mortality in patients with both HIV and cancer was significantly higher than expected on the basis of mortality rates for each disease separately [ 69 ].…”