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As individuals with HIV infection live longer due to highly active antiretroviral therapy (HAART), co-morbid conditions and infections, including liver cancers and viral hepatitis, warrant increased attention and action.
The multisite ASD Project followed 29,491 HIV-infected individuals receiving medical care in 11 U.S. metropolitan areas for an average of 2.4 years and a total of 69,487 person-years. ASD collected data on the presentation, treatment, and outcomes related to HIV infection, including viral hepatitis screening and liver-specific complications including hepatic neoplasms. Data were restricted to the HAART era, 1998-2004.
There were 25 participants with liver malignancies in the ASD cohort corresponding to a rate of 8.5 cancers/10,000 people living with HIV. Twenty two (88%) participants died and the remaining 3 were lost to followup. Fifteen (60%) of the 25 had hepatocellular carcinoma; 6 had metastatic adenocarcinoma, 1 each had lymphoma, hepatoblastoma, sarcoma, and poorly differentiated carcinoma. Thirteen of 25 (52%) individuals with liver malignancies were diagnosed with hepatitis C virus (HCV) and 10 (40%) with chronic hepatitis B virus (HBV) infection (including 2 participants with HBV and HCV co-infection). This corresponds to a relative risk of liver cancer among HCV and HBV infected individuals of 12.8 (95% confidence interval [CI] = 4.1-40.2) and 26.8 (95% CI = 8.1-88.9), respectively (relative to those without HBV or HCV diagnoses). The risk of malignancy in HIV-infected individuals with both HBV and HCV co-infection, relative to those with neither co-infection, was 16.8 (95% CI = 3.1-91.8). Four individuals did not undergo HBV or HCV screening, and their viral hepatitis serostatus remained undefined. Twelve percent of liver cancer patients also had a diagnosis of cirrhosis, relative to a 1 percent prevalence of cirrhosis overall (relative risk of liver cancer for those with cirrhosis = 10.2, 95% CI = 3.1-33.9). Incident liver disease and chronic HBV and HCV were diagnosed in 0.9, 1.8, and 4.7 per 100 person-years. HBV and HCV screening increased from fewer than 20% to over 60% during this period of observation (p<.001). Deaths occurred in 57% of those diagnosed with liver disease relative to 15% overall (p<.001). Overall, 10% of deaths occurred among individuals with a diagnosis of liver disease.
Despite care guidelines promoting screening for HBV and HCV, screening was not universally conducted or, if conducted, not documented. Due to elevated risks of liver cancer and other liver diseases, HCV and HBV screening and treatment of viral hepatitis among HIV-infected individuals should be a priority in the HAART era.
This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.