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Screening for Hepatocellular Carcinoma (HCC) in HIV/HCV-Coinfected Patients: Impact on Staging, Therapy, and Survival
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Reported by Jules Levin
CROI Feb 16-19 2010 SF
Marina Nunez1, Luciana Kikuchi2, Pablo Barreiro3, Mark Nelson4, Maria Eugenia Vispo3, Emma Page4, Rena Fox5, Edmund J. Bini6,7, Morris Sherman8, Norbert Brau9,10.
The Liver Cancer in HIV Study Group
Wake Forest University, Winston-Salem, NC, USA(1); Universidade de Sao Paulo, Sao Paulo, Brazil(2); Hospital Carlos III, Madrid,Spain(3); Chelsea and Westminster Hospital, London, UK(4); University of California San Francisco, San Francisco, CA, USA(5); New York University, New York, NY, USA(6); VA New York Harbor HCS, New York, NY, USA(7); University of Toronto, Toronto, ON, Canada(8); Bronx VA Medical Center(9); Mount Sinai School of Medicine, New York, NY, USA(10)
from Jules: HCV/HIV coinfected patients get dismissed, they don't get screened for HCV, they don't get screened for HCC (liver cancer), they don't get treated for HCV, as a result they are more likely to get HCC, to die sooner than if they were screened for HCC or received HCV treatment, they are less likely to be eligible for transplant, less likely to get HCC treatment and they are more likely to have incurable HCC. That's why HCV is the leading cause of death & hospitalization in HIV except perhaps for AIDS.
Summary and Conclusion
This study support extension of current guidelines to screen all HCV-infected patients with cirrhosis by ultrasonography every 6-12
(1) A large proportion of HIV/HCV-infected patients with HCC (43%) were not screened.
(2) HCC screening was associated with better liver function and earlier HCC stages.
(3) HCC screening was associated with higher eligibility for liver transplantation(by expanded Milan criteria)
(4) HCC screening was associated with more frequent use of potentially curative HCC therapy
(5) After adjustment of lead time bias, survival was betterin screened than in unscreened patients.
Background
· Sonographic screening for HCC in patients with chronic hepatitis B has been shown to prolong life.
· This has not yet been proven in HCV-infected patients.
· No studies are available examining the effect of HCC screening in HIV/HCV-coinfected patients
· This multi-center study applied published methods to account for lead time bias of screened subjects.
Screened Patients Have Better Survival
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