Screening for Liver Cancer in HIV/HCV Coinfected People

		SUMMARY: Nearly half of HIV/HCV coinfected individuals with liver cancer in an international study were never screened for hepatocellular carcinoma, but those who did undergo screening had their cancer detected at an earlier stage, leading to more effective treatment and improved survival, according to a report presented at the 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010) last month in Vienna.

By Liz Highleyman

Over years or decades, chronic hepatitis C virus (HCV) infection can progress to severe liver disease including cirrhosis and hepatocellular carcinoma (HCC), a form of primary liver cancer. Research shows that HIV/HCV coinfected individuals tend to experience more rapid liver disease progression than people with HCV alone.

HCC is more easily treated and the likelihood of success is greater if detected at an early stage. American Association for the Study of the Liver (AASLD) guidelines recommend that chronic hepatitis C patients with cirrhosis should be screened for HCC every 6-12 months. A blood biomarker, alpha-fetoprotein (AFP), can be used to screen for liver cancer, but ultrasound imaging is more accurate.

L. Kikuchi from Universidade de Sao Paulo in Brazil and colleagues from the U.S., Canada, U.K., Spain, and Italy looked at liver cancer outcomes among HIV/HCV coinfected patients with and without prior HCC screening.

This retrospective analysis included 70 coinfected participants with HCV-related liver cancer identified at 20 centers in North and South America and Europe between 1992 and 2009. Participants were considered to have been screened for HCC if they initially presented with an abnormal AFP level or liver imaging results, and not screened if they first presented when they developed symptoms.

Results

	Among 70 study participants, 39 (55.7%) had been screened for HCC.
	There was no significant difference between screened and unscreened patients with regard to age (50 vs 53 years), race/ethnicity, median HIV viral load, or median CD4 cell count (308 vs 227 cells/mm3).
	Screened patients were more likely than unscreened patients to present with earlier-stage liver cancer:
	Barcelona Clinic Liver Cancer (BCLC) stages A or B (least advanced): 69.2% of screened vs 19.4% of unscreened patients (P < 0.001); Lower mean Cancer of the Liver Italian Program (CLIP) staging score: 1.6 vs 2.5, respectively (P = 0.009); Lower mean Child-Turcotte-Pugh (CTP) score: 6.6 vs 7.5 (P = 0.027); CTP stage A (least severe): 61.5% vs 35.5% (P = 0.030).
	Screened individuals received effective HCC therapy more frequently than unscreened participants, though the difference did not reach statistical significance (64.1% vs 41.9%; P = 0.064).
	After adjusting for lead-time, screened patients had a longer median survival duration compared with unscreened patients (6.9 vs 3.8 months; P = 0.026).

Based on these results, the researchers concluded, "A large proportion of HIV/HCV coinfected patients with HCC were not screened for the malignancy."

"[S]creening for HCC in these patients was associated with significantly earlier HCC stage, increased use of effective HCC therapy, and with improved survival," they continued.

"These findings support the AASLD 2005 practice guidelines for HCC screening, and these guidelines should also be applied to HIV/HCV coinfected patients," they recommended.

Universidade de Sao Paulo, Sao Paulo, Brazil; Wake Forest University, Winston-Salem, NC; Hospital Carlos III, Madrid, Spain; Chelsea and Westminster Hospital, London, UK; Università degli Studi di Brescia, Brescia, Italy; University of California San Francisco, San Francisco, CA; University of Toronto, Toronto, Ontario, Canada; Bronx Veterans Affairs Medical Center, Bronx, NY; Divisions of Infectious Diseases and Liver Diseases, Mount Sinai School of Medicine, New York, NY.

5/28/10

Reference
L Kikuchi, M Nunez, P Barreiro, and others (Liver Cancer in HIV Study Group). Impact of screening for hepatocellular carcinoma (HCC) in HIV/HCV-coinfected patients on staging, therapy and survival. 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010). Vienna, Austria. April 14-18, 2010. (Abstract).