for Liver Cancer in HIV/HCV Coinfected People
Nearly half of HIV/HCV
coinfected individuals with liver cancer in an
international study were never screened for hepatocellular
carcinoma, but those who did undergo screening had
their cancer detected at an earlier stage, leading
to more effective treatment and improved survival,
according to a report presented at the 45th Annual
Meeting of the European Association for the Study
of the Liver (EASL 2010)
last month in Vienna.
Over years or decades, chronic
hepatitis C virus (HCV) infection can progress to severe
liver disease including cirrhosis
carcinoma (HCC), a form of primary liver cancer. Research
shows that HIV/HCV coinfected individuals tend to experience
more rapid liver disease progression than people with HCV alone.
is more easily treated and the likelihood of success is greater
if detected at an early stage. American
Association for the Study of the Liver (AASLD) guidelines
recommend that chronic hepatitis C patients with cirrhosis should
be screened for HCC every 6-12 months. A blood biomarker, alpha-fetoprotein
(AFP), can be used to screen for liver cancer, but ultrasound
imaging is more accurate.
L. Kikuchi from Universidade de Sao Paulo in Brazil and colleagues
from the U.S., Canada, U.K., Spain, and Italy looked at liver
cancer outcomes among HIV/HCV coinfected patients with and without
prior HCC screening.
This retrospective analysis included 70 coinfected participants
with HCV-related liver cancer identified at 20 centers in North
and South America and Europe between 1992 and 2009. Participants
were considered to have been screened for HCC if they initially
presented with an abnormal AFP level or liver imaging results,
and not screened if they first presented when they developed
70 study participants, 39 (55.7%) had been screened for
was no significant difference between screened and unscreened
patients with regard to age (50 vs 53 years), race/ethnicity,
median HIV viral load, or median CD4 cell count (308 vs
patients were more likely than unscreened patients to present
with earlier-stage liver cancer:
Clinic Liver Cancer (BCLC) stages A or B (least advanced):
69.2% of screened vs 19.4% of unscreened patients
(P < 0.001);
mean Cancer of the Liver Italian Program (CLIP) staging
score: 1.6 vs 2.5, respectively (P = 0.009);
mean Child-Turcotte-Pugh (CTP) score: 6.6 vs 7.5 (P
stage A (least severe): 61.5% vs 35.5% (P = 0.030).
individuals received effective HCC therapy more frequently
than unscreened participants, though the difference did
not reach statistical significance (64.1% vs 41.9%; P =
adjusting for lead-time, screened patients had a longer
median survival duration compared with unscreened patients
(6.9 vs 3.8 months; P = 0.026).
on these results, the researchers concluded, "A large proportion
of HIV/HCV coinfected patients with HCC were not screened for
"[S]creening for HCC in these patients was associated with
significantly earlier HCC stage, increased use of effective
HCC therapy, and with improved survival," they continued.
"These findings support the AASLD 2005 practice guidelines
for HCC screening, and these guidelines should also be applied
to HIV/HCV coinfected patients," they recommended.
Universidade de Sao Paulo, Sao Paulo, Brazil; Wake Forest
University, Winston-Salem, NC; Hospital Carlos III, Madrid,
Spain; Chelsea and Westminster Hospital, London, UK; Università
degli Studi di Brescia, Brescia, Italy; University of California
San Francisco, San Francisco, CA; University of Toronto, Toronto,
Ontario, Canada; Bronx Veterans Affairs Medical Center, Bronx,
NY; Divisions of Infectious Diseases and Liver Diseases, Mount
Sinai School of Medicine, New York, NY.
L Kikuchi, M Nunez, P Barreiro, and others (Liver Cancer in
HIV Study Group). Impact of screening for hepatocellular carcinoma
(HCC) in HIV/HCV-coinfected patients on staging, therapy and
survival. 45th Annual Meeting of the European Association for
the Study of the Liver (EASL 2010). Vienna, Austria. April 14-18,