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Tumor Characteristics and Survival in HIV-Infected Patients with Hepatocellular Carcinoma: the Impact of Surveillance
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HCV at ICAAC:
ICAAC: SVR Tied to Lower Progression, Mortality in HIV/HCV+ With Moderate Fibrosis - the importance of treating coinfected patients -
ICAAC: Lack of Clinically Relevant Drug Interactions Between Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate and Telaprevir - (09/12/13)
ICAAC: Hepatitis C Eradication Reduces Liver Decompensation, HIV progression, and Death in HIV/HCV-coinfected Patients with non-Advanced Liver Fibrosis - (09/12/13)
ICAAC: Acute C hepatitis in Japanese HIV-infected patients in this decade - (09/31/13)
ICAAC: CLINICAL CHARACTERIZATION OF HIV/HCV CO-INFECTED PATIENTS TREATED WITH DIRECT ACTING ANTIVIRAL AGENTS (in Miami)- (09/18/13)
ICAAC: Worse Response to PegIFN/RBV for HCV After Transplant in HIV/HCV+ vs HCV+
ICAAC: HIV Does Not Affect Chance of HCV Genotype 2 or 3 Responding to PegIFN/RBV
Reported by Jules Levin
53rd ICA AC 2013
September 10-13, Denver, CO
Antonio Diaz-Sanchez, Pilar Miralles, Ana Matilla, Teresa Aldamiz-Echevarria, Óscar Nunez, Ana Carrero, Beatriz Merino, Cristina
Diez, Rafael Banares, Gerardo Clemente, and Juan Berenguer*
Hospital General Universitario Gregorio Maranón & Instituto de Investigación Sanitaria Gregorio Maranón, Madrid, Spain
FREQUENT/TIMELY Followupfor their HCV is crucial in coinfected patients because they experience accelerated disease progression compared to mono infected HCV patients
from Jules: in this study 94-100% had cirrhosis; 50% had liver decompensation; 40% were diagnosed with HCC, liver cancer; 12-15% had metastasis; , 3-yd survival was 22-28% (SEE SLIDES BELOW). If a patient is found to have cirrhosis surveillance/followup is supposed to occur every 6 months!!!! EVEN if CURED if a patient had cirrhosis before cure they are supposed to do an MRI every 6 months forever to screen for cancer!!! Even if cured if patient had cirrhosis although risk for developing cancer decreases quite a lot if SVR/cure is achieved there still remains a risk for liver cancer. In the slides below you will see before the guidelines treatment after diagnosis was much less likely & more likely after the guidelines, survival was better after guidelines, receiving treatment reduced risk for death although not statistically significant.
STUDY OBJECTIVE: To assess tumor characteristics, surveillance practices,
treatment, and survival in PWHIV with HCC before and
after 2005, when the new AASLD guidelines for HCC
were published. Before & After the guidelines in this study authors reported the same percent of patients diagnosed with HCC, liver cancer (41%) no improvement.
very sad, coinfection was neglected here in USA; this is why coinfected patients globally & many in the USA have died, because they were diagnosed late with HCV, did not receive proper followup & surveillance for liver cancer & decompensation, & were not educated properly about starting treatment & the importance of treatment, and all too often received confusing or poor messaging from clinicians - often they were told they were ok, their ALTs were normal, and often these patients did not realize they had serious disease or needed regular followup & they would not return for care & followup in a timely manner......."It is essential thus, to identify cirrhosis using accurate noninvasive methods such as transient elastography; and perform HCC screening with ultrasonography (± AFP) in patients at risk"
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