HIV providers less likely to screen for liver cancer than hepatologists

Last Updated: 2015-08-19

By Will Boggs MD

NEW YORK (Reuters Health) - HIV providers are far less likely than hepatologists to screen chronic hepatitis B virus (HBV) infected patients for hepatocellular carcinoma (HCC), according to a recent database study.

The American Association for the Study of Liver Diseases (AASLD) recommends HCC screening every 6-12 months for high-risk patients with chronic HBV. Although the AASLD does not specify HIV infection as a risk factor for HCC, previous studies have found that HIV is associated with an increased risk for HCC.

"I was surprised by how few HIV patients completed screening despite their overall high risk factors," lead author of the study, Dr. Bevin Hearn of Carolinas HealthCare System in Charlotte, North Carolina, wrote in an email to Reuters Health. "I suspect a large reason for the poor adherence is due to visit time constraints and focus on HIV care."

Dr. Hearn and colleagues used the Mount Sinai Data Warehouse medical record database to compare HIV provider and hepatologist awareness of and adherence to AASLD guidelines for HCC screening and other aspects of chronic hepatitis B management.

Over the 2-year study period, 36.0% of patients seen in HIV practices completed HCC screening, compared with 81.8% of patients seen in hepatology practices (p<0.00001).

Fewer than half of HIV/HBV subjects in HIV practices completed HCC screening despite having characteristics that placed them at high risk for HCC.

Multivariable analysis found that patients seen by hepatologists were 5.5 times more likely to have HCC screening than patients seen by HIV providers. The odds of being screened for HCC also decreased with increasing age, according to the study published online August 3 in Clinical Infectious Diseases.

HIV providers and hepatologist achieved similar average scores on the knowledge-based questions.

About three quarters of hepatologists reported following AASLD guidelines most of the time, compared with just under half of HIV providers.

"Given that HIV/HBV co-infected patients are at higher risk for mortality from liver disease it is critical they undergo surveillance for HCC," Dr. Renumathy Dhanasekaran of the Mayo Clinic in Rochester, Minnesota, who was not involved in this study, wrote in an email to Reuters Health. "And this study shines light on the significant non-adherence to guidelines existing in this special population, thus calling for steps to correct the problem."

"Mount Sinai is in the process of creating electronic medical record alerts for HBV care and HCC screening," Dr. Hearn told Reuters Health. "I am hopeful that there will be real improvement as a result, and perhaps this tool could be used as a model for other practices."

SOURCE: http://bit.ly/1UT7S1L

Clin Infect Dis 2015.