Clinical

Liver cancer more aggressive in HIV-infected patients

Last Updated: 2004-12-21 14:04:50 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In HIV-infected individuals, hepatocellular carcinoma is largely related to chronic hepatitis C virus infection (HCV) and has a "more aggressive clinical course" than in HIV-negative individuals, AIDS researchers report.

Therefore, prevention strategies including the treatment of hepatitis C are advisable in the management of HIV/HCV-coinfected patients, they emphasize in the November 19th issue of AIDS.

"The main characteristics of HCC in HIV-positive subjects and their survival have been poorly described so far," Dr. Massimo Puoti from the University of Brescia and the HIV HCC Cooperative Italian-Spanish Group investigators note in the paper.

They compared the clinical and epidemiological features and outcome of HCC in 41 HIV-positive and 384 HIV-negative patients.

An association between HIV infection and HCV infection emerged in multivariate analysis adjusted for age and sex, with an odds ratio of 11 (p = 0.005). HIV infection was also associated with infiltrating tumors and/or extranodal metastasis at presentation, with an odds ratio of 11.8 (p < 0.001).

Based on this finding, they say "more frequent abdominal ultrasound screening and AFP testing are advisable, in order to allow diagnosis at a less advanced stage which may permit the use of surgical or loco-regional treatment."

HIV infection was independently associated with reduced survival, with a hazard ratio of 1.63.

Progression of HCC was the "main determinant of prognosis," the authors note, adding that in most cases, HCC presented in patients with well-controlled HIV infection. This supports findings from anecdotal reports and small case series.

It's also worth noting, according to the investigators, that HCC presents at a younger age in HIV-infected individuals and that the interval between the estimated date of first HCV exposure and first diagnosis of HCC is shorter.

This implies that "hepatocarcinogenesis could be a more rapid process in HIV/HCV-coinfected patients and, therefore, an increasing number of cases should be expected within the next few years in this population," they warn.

AIDS 2004;18:2285-2293.