There is a
relatively low incidence of hepatocellular carcinoma (HCC) among people living with HIV who have liver cirrhosis, results of a prospective Spanish study published
in the online edition of the Journal of
Acquired Immune Deficiency Syndromes show. During five years of follow-up,
the overall incidence was 6.72 per 1000 person-years. But incidence was
significantly higher among the participants with decompensated cirrhosis at the
start of the study compared to participants with compensated cirrhosis. All the study participants had hepatitis C virus (HCV) and/or hepatitis B virus (HBV) co-infection.
finding of our study was a clear trend towards a higher incidence of HCC among
patients with decompensated cirrhosis as compared with those with compensated cirrhosis,”
comment the authors.
Large numbers of people living with HIV have HBV and/or HCV co-infection. These co-infections
can cause liver cirrhosis. Liver disease, including HCC, is now an important
cause of serious illness and death in this group.
Information on the
risk of HCC for people living with HIV who have liver cirrhosis is largely derived
from retrospective studies involving people taking sub-optimal antiretroviral
Spain wanted to gain a clearer understanding of rates and risk factors for HCC
during the era of modern HIV medicine. They therefore designed a prospective
study involving people living with HIV who had cirrhosis; were receiving care at
hospitals across Spain between 2004 and 2005; and who continue to be monitored.
The investigators examined incidence of HCC, its epidemiological
characteristics, clinical presentation and outcome.
followed every six months. In the present study, the investigators examined
five-year follow-up data.
The study cohort
comprised 371 patients. Most (95%) had HCV co-infection and HBV was
present in 5%. Approximately three-quarters of participants were
diagnosed with cirrhosis three years before their enrolment in the present
study. Just over a quarter of individuals (26%) had decompensated cirrhosis at
the time of their recruitment to the cohort. At baseline, 90% were taking HIV
therapy and 60% had an undetectable viral load.
The participants in the study were
followed for a median of 60 months. During this time, ten were diagnosed with
HCC. Nine of these individuals had HCV co-infection and one had HBV. At
the clinic visit before HCC diagnosis, all the participants had a CD4 cell count
above 100 cells/mm3 and were taking antiretroviral therapy, 90% had
an undetectable viral load.
Six people died
after the diagnosis of HCC. Two people underwent liver transplantation.
incidence of HCC was 6.72 per 1000 person-years and the cumulative incidence
rate was 2.7%.
were significantly higher among people with decompensated cirrhosis at
baseline (20 per 1000 person-years) than in people with compensated cirrhosis
(4 per 1000 patient-years).
similar in people with and without HCV co-infection, HBV co-infection and triple
infection with HIV, HCV and HBV.
probability of developing HCC after six years of follow-up was 3%. The probability
was higher for people with decompensated cirrhosis at baseline compared to
those with compensated disease (5.8 vs 2%).
The probability of
progressing to HCC for people with baseline compensated cirrhosis was 1% at
two years and 2% at years four and six. This compared to a probability of 2% at
year two and 5.8% at years four and six for the people with decompensated cirrhosis.
cohort of cirrhotic patients with adequate control of HIV infection shows a
relatively low probability of developing HCC,” write the authors. “Incidence of
HCC is…higher in patients with decompensated liver disease at baseline.”
Follow-up of the participants will continue and the investigators are hopeful this will provide
evidence of “changing trends in the incidence of HCC in HIV-infected patients
with liver cirrhosis and viral hepatitis co-infection.”