www.hivandhepatitis.com

Liver Cancer Increasing among People with HIV/HCV Coinfection

Hepatocellular carcinoma (HCC) is a growing problem among HIV positive people coinfected with hepatitis C virus (HCV) in Spain, and it is often diagnosed at a late stage when it is difficult to treat, researchers reported in the January 1, 2013, issue of Clinical Infectious Diseases.

Over years or decades, chronic HCV infection can lead to serious liver disease including cirrhosis and HCC, a form of primary liver cancer. Research indicates that liver disease progression occurs more rapidly in HIV/HCV coinfected people, especially those who are already HIV positive when they acquire HCV.

Nicolás Merchante from Hospital Universitario de Valme and colleagues conducted a study of the clinical and epidemiological characteristics of liver cancer among people with HIV. The analysis included all HIV positive people diagnosed with HCC at 18 hospitals in Spain before the end of December 2010.

Results

• 82 cases of HCC among HIV positive patients were included in the analysis, all related to viral hepatitis coinfection.
• Most participants (81%) had hepatitis C, 7% had hepatitis B, and 12% had both.
• Since 1999, when the first case was diagnosed, HCC incidence increased progressively over time.
• 16 cases were diagnosed before the end of 2004, with the remaining 66 cases occurring after this point.
• Among HIV/HCV coinfected participants, HCC incidence rose from 0.2 to 2.8 cases per 1000 person-years between 2000 and 2009, with the largest jump in 2008-2009.
• Most patients with HCC (79%) died during follow-up, all but 2 due to complications related to liver cancer.
• The median survival time after HCC diagnosis was 91 days (interquartile range, 31 to 227 days).
• Among 11 patients who received potentially curative HCC therapy, 3 people died (28%).
• The mortality rate was much higher, at 87%, for the 71 participants did not receive curative therapy (including 22 who received non-curative therapies).
• Compared with cases of HCC diagnosed before 2005, people diagnosed during later years did not have a higher survival rate.

"HCC is an emerging complication of cirrhosis in HIV-infected patients," the researchers concluded. "A sharp increase in its incidence has occurred in those also infected by HCV in the recent years."

"Unfortunately, HCC is frequently diagnosed at an advanced stage, and mortality continues to be very high, with no significant changes in recent years," they added. "Earlier diagnosis, which may allow potentially curative therapy, is necessary."

2/15/13

Reference

N Merchante, E Merino, J López-Aldeguer, et al. Increasing Incidence of Hepatocellular Carcinoma in HIV-Infected Patients in Spain. Clinical Infectious Diseases 56 (1):143-150. January 1, 2013.